THE 
AMERICAN    HOSPITAL 


OF  THE 


TWENTIETH  CENTURY 


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EDWARD  F.  STEVENS,  ArcMtet 


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Digitized  by  the  Internet  Archive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/americanhospitaOOstev 


THE 
AMERICAN   HOSPITAL 

OF    THE 

TWENTIETH  CENTURY 


A  treatise  on  the  development  of  medical 
institutions,  both  in  Europe  and  in  America, 
since  the  beginning  of  the  present  century. 


By 

EDWARD  F.  STEVENS,  Architect 

Member  of  American  Institute  of  Architects 

Member  of  Province  of  Quebec  Association  of  Architects 

Member  of  American  Hospital  Association 


ILLUSTRATED 


NEW  YORK 

Architectural  Record  Publishing  Comipany 
1918 


;.}> 


To  Warren  LeVerne  Babcock,  M.  D.,  Su- 
perintendent of  Grace  Hospital,  Detroit, 
Michigan,  whose  advice  and  encourage- 
ment decided  the  writer  of  this  book 
to  devote  his  entire  practice  to  medical 
institutions,  this  book  is  respectfully  dedi- 
cated. 


\i  Irl   3*0  6 


THE  AMERICAN  HOSPITAL  OF  THE  TWENTIETH  CENTURY 

FOREfFORD 

In  visiting  the  liospitals  of  Europe,  one  finds  on  every  hand  splendid  examples 
of  hospital  architecture.  The  administrators  of  these  institutions  take  pride  not 
only  in  laying  before  the  foreign  visitor  for  inspection  the  institution  itself,  but 
in  providing  him  with  carefully  prepared  plans  and  descriptions  of  the  institution 
and  its  equipment.  Everywhere  one  can  obtain  profusely  illustrated  books  on  the 
modern  hospitals  of  the  locality,  books  written  and  published  by  hospital  admin- 
istrators, architects,  and  engineers.  These  books  are  most  helpful  to  the  native 
as  well  as  to  the  foreigner. 

While  visiting  these  foreign  institutions,  the  writer  has  been  asked  repeatedly 
for  the  names  of  recent  books  on  American  hospitals.  Such  books  are,  alas,  very 
few  in  number,  and  there  are  none  commensurate  with  the  rapid  growth  and 
development  of  the  modern  American  hospital. 

It  is  in  response  to  this  demand  that  the  writer  has  endeavored  to  collect 
plans  and  information  concerning  a  few  of  the  many  good  institutions  recently 
finished  or  under  construction,  with  the  hope  that  interest  in  the  publication  of 
such  works  will  grow  and  that  this  book  will  be  only  a  forerunner  of  much 
more  comprehensive  treatises.  It  is  not  the  writer's  intention  to  criticise  the  plans 
of  the  institutions  here  shown,  but  to  present  them  as  various  solutions  of  the 
great  problems  of  housing  and  caring  for  the  sick  and  to  point  out  a  few  of  the 
findings  of  his  own  experience  in  the  planning  of  more  than  fourscore  hospitals 
and  institutions.  The  field  is  so  broad  that  it  is  impossible  more  than  to  touch 
upon  the  various  points. 

If  frequent  mention  is  made  of  hospitals  in  Europe,  it  is  for  the  purpose 
of  comparison,  with  the  hope  that  the  study  and  comparison  may  interest  the 
reader,  as  it  did  the  writer  in  collecting  the  data. 

The  chapters  on  the  Ward  Unit,  the  Surgical  Unit,  the  Medical  Unit,  and 
the  Equipment  are  taken  largely  from  papers  by  the  writer  which  were  read 
before  the  American  Medical  Association  and  the  American  Hospital  Association. 

The  chapters  on  Heating,  Ventilation,  Plumbing,  and  Landscape  Work  have 

been  reviewed  and  suggestions  given  by  prominent  specialists  in  each  line,  for 

which  advice  the  writer  is  much  indebted. 

Edward  F.  Stevens. 

Boston,  February,   1918. 


OD|»yn;fht  M8 


THE  AiMERICAN   HOSPITAL  OF  THE 
TWENTIETH   CENTURY 


Chapter 


C  ONTENTS 

I. 

In   General 

Page 
1 

II. 

Administration  Department 

11 

III. 

The  Ward  Unit 

16 

IV. 

The  Surgical  Unit         .        ". 

57 

V. 

The  Medical  Unit 

67 

VI. 

The  Maternity  Department 

78 

VII. 

The  Children's  Hospital 

95 

VIII. 

The  Contagious  Department 

108 

IX. 

The  Psychopathic  Department 

119 

X. 

The  Tuberculosis  Department 

130 

XI. 

(  Social    Service 
Special  Departments  •   Out-patient 

f  Pathological  &  Roentgen-R 

ay  ) 

XII. 

The  Small  Hospital       ..... 

155 

XIII. 

The   Xurses'   Residence 

175 

XIV. 

The  Kitchen   and  Laundry 

185 

XV. 

Heating,    \"entilation.    Plumbing 

196 

XVI. 

Details  of  Construction  and  Finish 

208 

XVII. 

Equipment            .            .... 

217 

XVIII. 
XIX. 

Landscape  Architecture  as  Appli( 
War  Hospitals       .... 

;d  to 

Hos 

pitals 

228 
239 

(general  3nbex 


Page 

Administration    Department 11 

American    Hospitals 6 

Artificial  Lighting 58,  212 

Barmbeck  (Hamburg)  Hospital 4 

Barre  (Vermont)   Citj-  Hospital 160 

Baths,  Limited  Use  of 18 

Bed  Space,  Proportion  to  Utilities 18 

Bispebjerg  Hospital 5,  21 

Boston   Consumptives'   Hospital 134 

Bridgeport  Hospital 66,  84,  101 

Brigham  Hospital,  Peter  Bent 6,  11,  22 

Buildings,  Character  of 2 

Cable     Memorial     Hospital.     Benjamin 

Stickney    162 

Chicago  Lying-in  Hospital 86 

Children's   Hospitals 95 

Cincinnati   General   Hospital 26,65 

Classification  of  Patients 17 

Clothes    Closets 208 

Clothing,  Care  of 219 

Comfort  of  Patients 17 

Contagious    Department 108 

Creche  or  Nursery 80 

Day  Rooms 17 

Deaconess  Hospital,  Concord,  Mass....   159 

Delivery    Rooms 80 

Details   of  Construction 208 

Disinfecting  Room 223 

Disturbing    Noises 18 

Drinking    Fountains 207 

East  New  York  Dispensary 152 

Equipment    217 

Essentials  in  Ward  Buildings 17 

European    Examples 4 

European  Influence 2 

Floors,    Quiet 211 

Floor  Alaterial 211 

Ford   Hospital,   Henry 27 

Forsyth   Dental   Clinic 96 

Galloway  Alemorial  Hospital 32 

German  Hospital,  Chicago 32 

Grace  Hospital,  Detroit .....57,  62 

Greenville   (Me.)   Hospital 162 

Growth  of  Hospitals 1 

Hamot    Hospital 35 

Hardware    209 

Harper   Hospital 27 

Heating  of  Operating  Rooms 198 

Heating  and  Ventilating 196 

Hospital   Entrance 41 

Illinois  Central  Hospital 36 

Kingston   Avenue   Hospital 110 

Kitchen  and  Laundry 185 

Kitchen,  Requirements  of 185 

Kitchen  Utensils 188 

Laboratories    139 

Landscape    Architecture 228 

Lane  Home,  Harriet 97 

Laundry  and  Disinfecting  Plant 189 

Lighting.   Artificial 58,  212 

Macon    Hospital 33 


Page 

Mansfield  General  Hospital 34 

Mason    Hospital 172 

Massachusetts  General  Hospital 11 

Massachusetts    Homeopathic    Hospital, 

Contagious    Department 118 

Massachusetts  Psychiatric  Hospital....   126 

Maternity    Department 78 

Mattresses   218 

Mayo    Clinic 145 

Meadville   City  Hospital 82 

Medical   Baths 67 

Medical    Unit 67 

Medicine    Closets 208 

Melrose  Hospital 100,  162 

Militarj-   Hospital    at    D'lssy-les-Mouli- 

neaux    240 

Munich  Psj^chiatric  Clinic 119 

Munich-Schwabing  Hospital 5,  21 

Newton    Hospital 81 

Newton  Hospital  Grounds 229 

New  York  City  Hospital 65 

Noises,   Minimizing  of 18 

Nurses'    Residence 175 

Nurses'   Signal 214 

Nurses'   Stations 215 

Nurses'   Work   Room 60 

Nursery    80 

Ohio  Valley  General  Hospital 11,  33,  65 

Operating  Room  Walls 214 

Operating   Unit 57 

Out-Patient    Department 139 

Pasteur    Hospital 108 

Pathological  Department 139 

Phipps  Psychiatric  Clinic 129 

Plumbing    196 

Pneumatic   Chamber 77 

Providence  Citj^  Hospital 110 

Psj'chopathic   Department 119 

Quiet  Rooms 17 

Quincy    Hospital 62 

Rhode  Island  General  Hospital 65 

Rigs  Hospital 21 

Roentgen-Ray  Department 142 

Royal  Victoria  Hospital,  Ross  Pavilion. .  36 
Ruptured  and  Crippled,  Hospital  for....   101 

St.  Georg  Hospital 62 

St.  Luke's  Hospital,  Jacksonville.  .  .9,  27,  110 

St.  Luke's  Hospital,  New  Bedford 84 

St.   Thomas   Hospital 96 

San  Francisco  Hospital 35 

Scrub-up    Sink 60 

Sea  View  Hospital 132 

Serving  Kitchens 18,  187 

Sick  Children,  Hospital  for 96,  100.  115 

Sick     Children,     Hospital    for, — Nurses' 

Residence    183 

Sink  Room 223 

Sites  for  Hospitals 1 

Small  Hospital,  The 155 

Social  Service  Work 150 

Southern   Pacific  Hospital 75 

Sterilizers  221 


Page 

Sterilizing  Room 60 

Sunshine,  Importance  of 17 

Surgical   Unit 57 

Talitha  Cumi  Maternity  Home 81 

Thomas   Hospital,   Josiah   B.    (Peabody, 

Mass.)  171 

Toronto  General  Hospital 8 

Tuberculosis    Department 130 

Twentieth  Century  Hospital,  Ideal 4 

U.  S.  Overseas  Hospitals 247 

Utility  Room. 18 

Utrecht  Psychiatric  Clinic 119 

Vacuum   Cleaners 215 


Page 

Wall  Decoration 213 

Walls,  Material  for 214 

War  Hospitals 239 

Ward,  Size  of 17 

Wards,  Roof 17 

Ward  Unit 16 

Ward  Units,  European 20 

Wesson  Maternity  Hospital 86 

Willard  Parker  Hospital 110 

Worcester  City  Hospital 101 

X-Ray   Department 142 

Yonkers  Homeopathic  Hospital 86 

Youngstown  Hospital 30,  62 


Sllusitrationsi 


Page 
Augusta  General  Hospital,  Nurses'  Resi- 
dence     183 

Autopsy  Tables 205,  206 

Barmbeck  III  Hospital,  General  Plan...       4 
Barre  City  Hospital. 

Exterior 161 

Floor  Plans 159,  160,  161 

Operating  Room IZ 

Base  Hospital,  Plan 246 

Bath,  Admitting 202 

Bath.    Baby 203 

Beds,  Adjustable 217,  218,  219 

Bedside    Tables 220 

Beverly  Hospital,  Plan  of  Grounds 235 

Bispebjerg  Hospital. 

General  Plan 5 

Ward  Unit 22 

Boston  Consumptives'  Hospital 138 

Bridgeport  Hospital. 

Birdseye  View^ 20 

Major  Operating  Room 68 

Operating  Room 66 

Plot    Plan 19 

Viev^  in  Operating  Department 67 

Serving   Kitchen 193 

Bridgeport  Hospital,  Maternity  Pavilion. 

First  Floor  Plan 36 

Second  and  Third  Floor  Plans 2>1 

Children's   Ward 101 

Creche    83 

Day   Room 102 

Delivery    Room 84 

Exterior     36 

Private  Room 39 

Ward 39 

Bridgeport  Hospital,  Nurses'  Residence. 

Exterior    177,  178 

Nurse's  Room 180 

Plans 176 

Study    Room 178 

Superintendent's  Room 179 

Bridgeport  Flospital,  Service  Building..    194 
Brigham   Hospital,    Peter    Bent. 

Airing    Balcony 26 

General  Plan 7 

General  View 14 

Interior  of  Wards 25 

View  in  Pharmacy 13 

View  in  Rotunda 13 

Ward  Floor  Plans 24 


Page 
Buffalo  General  Hospital,  Private  Pavi- 
lion. 

Operating  Department 75 

Typical  Ward  Plan 57 

Cabinets,  Built-in 67 

Cable     Memorial     Hospital,     Benjamin 
Stickney. 

Exterior    164 

Plans    162,  163 

Plan  of  Grounds 236 

Canton  Hospital  School 199 

Chart  Cases 215 

Chicago  Lying-In  Hospital,  Plans 87,  88 

Children's  Hospital,  Philadelphia. 

Out-Patient  Department,  Plans 147 

Cincinnati  General  Hospital. 

Exterior  of  Wards 28 

General  Plan 8 

Interior  of  Ward 27 

Kitchen  190,  191 

Ward    Plan '     26 

Cincinnati  General  Hospital,  Operating 

Building,  Plans 70,  71 

Cincinnati   General  Hospital,   Receiving 

Building 16 

Clothing   Lockers 221 

Deaconess     Hospital,     Concord,     Mass., 

Plans 158 

Details  of  Door  Finish 209 

Details  of  Linen  Closet 211 

Details  of  Window  Finish 210 

D'Issy-les-Moulineaux,  War  Hospital. 

General    Plan 239 

Plans  140-145 

Diet  Kitchen 225 

Door  Frames,  Hospital 209 

East     New     York     Dispensary,     Floor 

Plans    152,  153 

Floor  Trap 205 

Fluoroscope  (Upright) 147 

Food    Truck 224,  227 

Footstools    220 

Ford   Hospital,    Henry,   Ward    and   Op- 
erating Plan 29 

Forsyth  Dental  Clinic,  Wall  Decoration.  97 
Galloway    Memorial    Hospital,    Second 

Floor  Plan 40 

German  Hospital,  Chicago,  Floor  Plans.41,  42 
Grace  Hospital,  Operating  Department.  59 
Greenville  Hospital,  Plans 165 


Page  Page 

Haniot  Hospital.  New    York    City    Out-Patient    Depart- 

Operating   Plan 74  ment  148,  149 

Private  Ward,  Exterior 47  Ohio  Valley  General   Hospital. 

Private  Ward,  Plan 47  Airing  Balcony 43 

Harper  Hospital,  Ward  Plans 30  Fourth  Floor  Plan 63 

Heating.  General  View 15 

Details  of  Vent  Flue 197  First  Floor 15 

Direct-Indirect    Radiators 196  Ground  Floor  Plan 43 

Temperature  of  Patients'  Rooms 197  Isolation    Department 115,  116 

Haynes    Nurses'    Home,   J.    Manchester  Kitchen    192 

(Augusta  General  Hospital) 183  Operating  Room 64 

Heywood  Hospital,  Plan  of  Grounds. .  . .  235  Rear   View 44 

Hospital    Beds 217-219  X-Rav  Department 79 

Hospital  Help's  Building 184      Pasteur  Hospital,  Ward  Plan 108 

Illinois  Central  Hospital,  Floor  Plans. 50,  51       Pasteurizing    Room 226 

Jacksonville       Tuberculosis       Hospital,  Pneumatic    Chamber 11 

Plans    132,  133  Quincy  City  Hospital.  Operating  Build- 
Kings    Countv    Hospital,    Help's    Build-  ing. 

ing    ." 184  First  Floor  Plan 62 

Kingston  Avenue  Hospital 114  Operating  Room 200 

Kitchen    Cabinet 211  Scrub-up  Sink 200 

Lighting   Fixtures 212,  213  View  in  Operating  Room 63 

Linen    Cabinets 211       Radiators    196 

Macon  Hospital.  Revolving  Airing  Balcony 131 

First  Floor  Plan 45  Rhode  Island  General  Hospital,  Operat- 

Out-Patient  Department 151  ing  Department 64 

Private    Pavilion 46  Rigs  Hospital. 

Roof  Plan 44  View  in  Kitchen 186 

Mansfield    General   Hospital,   First   and  Ward  Unit 22 

Second  Floor  Plans 48,  49  Rockefeller  War  Hospital. 

Mason  Hospital.  Construction    268 

Exterior 174  Interior   of  Ward 268 

Plans    172,  173  Royal  Victoria  Hospital,  General  Plan .     52 

Massachusetts  General  Hospital.  Royal  Victoria  Hospital,  Ross  Pavilion. 

Administration   Building 12  Distant  View Frontispiece 

Basement  Plan 13  Entrance    Lobby 56 

Operating    Department 58  Entrance  to  Grounds 238 

Original    Building 11  Fifth  Floor  Plan 54 

Zander  Room 79  Front    View 55 

Alassachusetts    Homeopathic    Hospital,  Ground  Floor 53 

Isolation  Building.  Floor  Plans 117  Kitchen    192 

Massachusetts   Psychiatric  Hospital.  Operating  Room  Heating 200 

Exterior     125  Serving    Kitchen 193 

Floor   Plans 126-128  Typical  Floor 53 

Alaternity  Beds 219  W'est  Side 54 

Mayo   Clinic,   Floor   Plans 143-146  Ruptured    and    Crippled,    Hospital    for, 

Meadville  City  Hospital,  Maternity  De-  Floor  Plans 103,  104,  105 

partment   82  San  Francisco   Hospital. 

Medicine    Closet 206,210  Maternity    Department 86 

Melrose  Hospital.  Medical  Department 80 

Children's   Ward 106  Typical  Ward  Unit 49 

Exterior 169  St.  George  Hospital. 

General    Plan 166  Operating    Department 60 

Interior    170  Pathological  Department 142 

Floor    Plans 167,  168  St.  Luke's  Hospital,  Jacksonville. 

Militarv       Hospital       D'Issy-les-Mouli-  Administration  and  Operating  Depart- 

nea'ux 239,240,241,243  ments    69 

Morse       Hospital,       Leonard,       Nurses'  Corridor  and  Public  Wards 34 

Home,  Plans 182  Exterior  of  Private  Ward }>2 

Munich  Psychiatric  Clinic 120,  121  General  Plan 9 

Munich-Schwabing  Hospital.  Laundry,    Plan 193 

General  Plan 6  Private  Ward,  Plans 31 

Medical  Treatment  Department.  Plan.     Id  Public  Ward,  Plan ZZ 

Pathological   Department 139-141  Exterior  of  Public  Ward 35 

Ward    Unit 23  St.  Luke's  Hospital,  Isolation   Building. 

Newton  Hospital,  Newton,  Alass 230-233  Admitting  Bath 202 

New    York     City    Hospital,     Opei  ating  Exterior Ill 

Room    65  Plans 109 


Page 

Private  Room 112 

Serving   Kitchen 112 

Three-Bed    Ward 113 

Ward    Plan 31 

St.       Luke's       Hospital,       Jacksonville, 
Nurses'  Residence. 

Exterior    181 

Plans 180 

St.     Luke's     Hospital,     New     Bedford, 

Maternity    Department 85 

St.  Thomas  Hospital,  Children's  Ward..     96 

Sea  View  Hospital. 

Dining  Building 135 

General  Plan 134 

Group  Building 135,  136 

Ward  Unit  Plans 137 

Serving_  Kitchens 224,  225,  226 

Sick  Children,  Hospital  for. 

Exterior   View 99 

Floor  Plan 100 

Interior    116 

Laundry 195 

Nurses'    Residence 175 

Out-Patient  Department 154 

Pasteurizing    Room 226 

Sink    Room 223 

Special  Door  Hardware 212 

Sterilizers,  Box  Type 222 

Surgeons'  Scrub-up  Bowls 203,  205 

Talitha  Cumi  Maternity  Home. 

Plans 81 

Plan  of  Grounds 234 

Thomas  Hospital,  Josiah   B.    (Peabody, 
Mass.)    170,  171 


Page 
U.  S.  Overseas  Hospitals. 

Details  of  Construction 269-272 

Details  of  Plumbing 273,  274 

Elevations    266 

General  Plan 250 

Plans  of  Units 252-265 

Utrecht  Psychiatric  Clinic. 

Interiors    124 

Plans    122,  123 

Vent  Ducts 197 

Ventilating  through  Closet 198 

Ventilation    Roof 199 

Virchow  Hospital. 

General  Plan 3 

Kitchen    189 

Surgical  Ward   Unit 21 

View  in  Grounds 229 

Water  Bed 78 

Wesson  Maternity  Hospital,  Plans 89,90 

Western  Infirmary,  Out-Patient  Plan..   148 

Willard  Parker  Hospital,  Plans 114 

Williams  Private  Sanatorium. 

Operating  Room 72 

Plans 156,  157 

Worcester     City     Hospital,     Children's 

Building   106,  107 

Yonkers  Homeopathic  Hospital. 

Exterior    93 

Plans   91,  92 

Youngstown    Hospital. 

Operating  Department 61 

Ward  Unit 35 

Zander  Room 79 


THE    AMERICAN    HOSPITAL     OF    THE 
TWENTIETH    CENTURY 

CHAPTER  I. 

3n  General 


Historical.  It  would  be  vastly  inter- 
esting to  trace  the  evolution  of  hospital 
building  and  equipment  from  the  crude 
structures  of  ancient  times  designed  to 
house  the  sick,  to  the  comprehensive  hos- 
pital of  today,  and  to  show  how  architec- 
ture and  equipment  have  advanced  stride 
for  stride  with  medical  and  surgical  prog- 
ress; but  in  these  days  of  vivid  and  in- 
sistent research  and  accomplishment 
there  is  no  time  for  comparative  specula- 
tion or  historical  review.  All  our  ener- 
gies are  needed  to  keep  pace  with  the 
newly  devised  methods  which  are  con- 
stantly being  put  in  practice  and  to  fa- 
cilitate these  achievements  by  proper 
housing  and  equipment.  Hospital  build- 
ing, since  the  beginning  of  the  twentieth 
century,  has  increased  enormously. 

In  1911  Dr.  Charles  P.  Emerson*  stated 
the  number  of  hospitals  in  the  United 
States  to  be  2,547 ;  and  the  data  available 
in  1914  gave  the  total  number  as  7,000, 
housing  1,000,000  persons,  of  whom  580,- 
000  were  patients.  Even  Avith  this  vast 
number,  only  aboutf  "twelve  per  cent,  of 
the  sick  people  in  this  country  who  are 
ill  enough  to  need  a  doctor  are  cared  for 
in  hospitals." 

The  line  of  advance  has  been  influenced 
not  only  by  the  medical  men  and  the  nurs- 
ing force,  but  by  the  social  welfare 
worker,  the  hospital  commission,  the  so- 

*Hospital   Management,   W.   B.   Saunders   Co. 
tEditorial   Modern   Hospital,   Vol.    VIII,    No.    1. 


ciety  to  suppress  tuberculosis,  and  the 
public  at  large ;  for  the  people  are  realiz- 
ing that  the  hospital  is  built  to  benefit 
humanity  and  not  to  aiTord  a  place  in 
which  to  die.  "All  hope  abandon  ye  who 
enter  here"  no  longer  is  the  appropriate 
inscription  for  the  hospital  gate.  But 
this  advance  has  been  by  gradual  steps, 
— an  improved  ward  unit  here ;  better 
methods  of  service  there ;  building  up 
thus  by  experimental  work  and  research 
a  standard  to  meet  the  needs  as  they  ap- 
pear, and  with  the  ever-increasing  feel- 
ing that  the  welfare  of  the  patient  is  of 
more  importance  than  the  zeal  for  sci- 
ence. 

Hospital  Sites.  Before  taking  up  the 
subject  of  the  planning  of  the  hospital 
itself,  we  must  consider  the  very  impor- 
tant subject  of  the  site.  Attractive  loca- 
tions for  public  buildings  or  even  for  resi- 
dences are  rarely  suitable  for  hospitals. 

The  improvement  of  the  patient,  w^hich 
is  the  fundamental  purpose  of  the  insti- 
tution, depends  in  large  measure  on  its 
situation  and  environment — the  contour 
of  the  land,  the  surrounding  country,  the 
aspect,  the  accessibility  for  friends  of  the 
patient  and  for  visiting  physicians,  re- 
moteness from  disturbing  influences,  a 
site  of  sufficient  size  to  insure  privacy, 
are  all  contributory  elements  for  the 
process  of  recovery. 

A  southern  exposure  is  always  desir- 
able,  with  the  land   sloping  toward  the 


THE  AMERICAN   HOSPITAL 


south.  If  in  the  country,  it  is  still  more 
advantageous  if  the  north  is  protected 
by  evergreen  trees. 

'  Enough  land  should  be  provided  to  al- 
low for  growth.  In  building  even  the 
first  portion,  the  future  should  be  con- 
sidered and  the  plans  for  the  develop- 
ment of  the  entire  institution  studied  and 
worked  out  so  that  the  structures  may 
be  grouped  to  the  best  advantage.  What- 
ever portion  is  built,  it  should  be  done 
with  reference  to  the  completed  whole. 
Oftentimes  the  central  or  administration 
building  is  all  that  can  be  managed  in  the 
beginning,  and  in  this  must  be  disposed 
temporarily  all  the  departments. 

If  the  site  is  in  the  city,  the  same  care 
in  selection  should  be  exercised.  Smoke 
from  adjoining  chimneys,  noise  from 
nearby  railroads,  and  proximity  to  a 
noisy  thoroughfare  or  factory  are  men- 
aces to  be  considered. 

The  suggestions  for  treating  the 
grounds  of  an  institution  will  be  taken 
up  in  the  chapter  on  Landscape  Archi- 
tecture. 

Buildings.  The  building  or  buildings 
should  be  simple  in  style  and  designed  to 
make  a  pleasing  impression  upon  the  pa- 
tients with  the  entrance  speaking  a  wel- 
come. The  motto  suggested  for  the 
Virchow,  in  Berlin,  might  well  be  placed 
over  the  entrance  of  many  another  hos- 
pital— "While  treating  the  disease,  do  not 
forget  to  treat  the  man." 

Hospital  planning  demands  the  same 
careful  thought  that  is  the  foundation  of 
any  modern  successful  business  enter- 
prise. It  is  essential  in  the  shoe  factory, 
the  paper  mill,  or  the  business  establish- 
ment to  so  plan  that  the  raw  materials 
may  be  assembled  and  the  finished  prod- 
uct delivered  with  the  fewest  possible  in- 
tervening motions.  In  the  hospital 
the  patient,  the  food  and  the  treat- 
ment may  be  termed  the  raw  material. 
AA''hatever  conduces  to  recovery,  the  con- 
valescent being  the  finished  product,  is 
of  business  importance  in  the  hospital. 
The  care,  the  comfort,  the  convenience 
and  the  food,  together  with  the  treatment, 
are  the  processes  of  manufacture.  The 
hospital  planner  must  seek  to  eliminate 
here  all  lost  motion  or  unnecessary  work. 

In  the  factorv  the  savin?  of  time  in  anv 


of  the  processes  adds  to  the  annual  prod- 
uct, and  in  the  hospital,  likewise,  care- 
ful scientific  nursing,  freedom  from  dis- 
turbing elements  and  everything  that  can 
help  early  convalescence,  add  to  the  ef- 
ficiency of  the  institution.  With  the  de- 
mands for  accommodations  that  are  made- 
in  these  days,  any  factors  that  w^ill  in- 
crease the  percentage  of  hospital  capacity 
will  be  truly  valuable.  Location  is  here 
most  important,  an  environment  that  will 
be  an  uplift  to  the  patient;  an  outlook 
that  while  distant  from  industries  may 
still  remind  the  patient  that  he  is  a  part 
of  the  world's  Hfe  and  activity,  sunlight 
and  ventilation  and  the  modern  fresh  air 
balcony ;  these  items  and  many  others  are 
factors  toward  increased  hospital  capa- 
city. Internal  disturbances  should  be 
avoided  by  planning  the  noisy  rooms  at 
a  distance  from  the  wards  and  there  arc 
many  important  relations  of  the  utilities 
to  be  considered,  a  single  example  of 
which  may  be  the  illumination  in  such  a 

Influence  of  European  Hospitals.  The 
good  influence  of  European  hospitals  is 
shown  in  many  of  our  modern  American 
institutions.  While  we  would  not  con- 
sider duplicating  any  one  European  in- 
stitution, we  do  receive  from  them  valu- 
able suggestions  for  the  solution  of  many 
a  perplexing  hospital  problem.  The  gen- 
eral relation  of  one  department  to  another, 
the  method  of  preparing  and  serving 
food,  the  housing  and  treatment  of 
patients,  the  orientation  and  environ- 
ment, and  the  proportion  of  sunlight  and 
shadow  are  some  of  the  things  upon 
which  we  may  receive  enlightenment. 
The  hospital  which  would  be  perfect  and 
which  would  fulfill  the  climatic  condi- 
tions of  southern  France,  however, 
would  be  entirely  unsuitable  in  our 
northern  states. 

If  we  can  put  the  European  hospital 
on  our  dissecting  table  and  remove  the 
part  we  cannot  use,  we  will  still  have  a 
pretty  good  portion  of  the  body  left. 
By  this  metaphor  I  do  not  assume  that 
hospital  architecture  is  a  dead  subject — 
far  from  it.  It  is  ver\'  much  alive.  Only 
last  week  our  medical  co-worker  asked  to 
have  provision  made  for  a  patient  in  a 
warm,  closed  room,  with  hot  baths ;  yes- 
terday, the  same  patient  was  to  be  kept 


OF   THE   TWENTIETH   CENTURY 


FIG.    1.      GENERAL    PLAN,    RUDOLPH    VIRCHOW    HOSPITAL. 

in  the  open  air ;  today,  ice  baths  are  pre-  the  ideal  ward  unit ;  in  another,  a  service 

scribed;  and  we  must  study  the  cHnics  building  of  peculiar  fitness;  and  in  still 

very   closely   to   find   out    what   will   be  another,  the  perfect  floor   (although  the 

wanted  tomorrow,  for  the  hospital  archi-  ideal  hospital  floor  does  not  seem  to  have 

tect  must  meet  the  latest  demand.  been   discovered    yet).      One    institution 

In  one  foreign  institution  we  may  find  Avill  have  an  ideal  operating  or  medical 


THE  AMERICAN   HOSPITAL 


department,  while  in  others  the  architects 
will  have  solved  new  problems  in  detail 
and  equipment. 

The  twentieth  century  hospital, 
whether  built  in  Spain,  Russia,  or  the 
United  States,  has  one  common  condi- 
tion in  its  program — that  is,  to  give  the 
patient  the  best  chance  for  recovery. 
If  a  more  thorough  study  of  sanitation, 
ventilation,  nursing,  disturbing  elements, 
orientation,  and  environment,  one  or  all, 
will  help  us  to  design  buildings  that 
hasten  convalescence  and  produce  the  de- 
sired results,  then  that  information  must 


out  grounds  and  parks,  with  their  walks 
and  drives,  become  the  ideal  place  for 
convalescents.  One  of  the  rules  of  these 
parks  is  that  on  every  third  day  they  are 
for  the  sole  use  of  the  patients,  every 
third  day  for  the  sole  use  of  the  staff, 
and  every  third  day  for  the  sole  use  of 
the  nurses. 

The  surgical  group,  on  the  left  of  the 
main  axis,  is  connected  with  the  operal;- 
ing  building,  while  the  medical  group  has 
the  bath-house  occupying  the  same 
strategic  position.  The  isolation  group 
occupies     a    portion    of    the    extensive 


Allgene  nes   Krankenhaus  Hamburfl  Sarmbeck 


Z^^^^Ws;:^ 


FIG.  2.     BARMBECK  HOSPITAL,  HAMBURG.     GENERAL  PLAN. 


be  obtained ;  and,  if  necessary,  we  should 
be  willing  to  circle  the  globe  for  it. 

Some  European  Hospitals.  A  few  ex- 
amples of  European  hospitals  will  show 
some  of  the  features  which  have  inter- 
ested the  writer  in  his  study  of  the  sub- 
ject. 

Perhaps  the  most  familiar  of  the  mod- 
ern hospitals  is  the  Mrchow  (Fig.  1)  at 
Berlin.  This  was  built  by  Architect 
Ludwig  Hoffmann  in  1907,  and  is  of  the 
pure  pavilion  plan.  It  has  a  capacity  of 
two  thousand  beds.  With  the  exception 
of  two  ward  units  connected  with  the 
surgical  or  operating  buildings  and  the 
administrative  group,  the  buildings  are 
all  isolated  and  are  of  one  story  so  far  as 
the  patients  are  concerned.  Owing  to  the 
ease  with  which  the  patients  can  be  taken 
from  the  buildings,  the  beautifullv  laid- 


grounds  on  the  south,  and  the  service 
buildings  on  the  north. 

The  ward  pavilions,  of  which  there  are 
twenty  practically  alike,  consist  of  two 
twenty-bed  wards,  with  service  at  the 
center  and  at  the  ends,  and  with  room 
for  attendants  in  the  second  story  of  the 
central  portion. 

The  floors  of  the  wards  are  elevated 
but  a  few  feet  above  the  ground,  giving  a 
ready  entrance  for  the  patients  and  for 
the  food,  both  of  which  are  carried  over- 
ground. 

The  new  Bannbeck  III,  City  Hospital 
at  Hamburg  (Fig.  2),  built  by  Baurat 
F.  Ruppel,  consists  of  forty-four  build- 
ings, and  wall  house  fifteen  hundred 
patients.  In  this  plan  Ruppel  has  varied 
somewhat  from  his  usual  method,  in  plac- 
ing the  center  of  the  medical  unit — the 


OF    THE    TWENTIETH    CEXTURY 


bath-house — on  the  axis  of  his  plan.  In 
the  St.  Georg,  the  Eppendorf,  the  Mr- 
chow,  and  other  large  German  hospitals 
the  bath-house  is  placed  on  the  medical 
side,  balancing  the  operating  building  as 
the  center  of  the  surgical  side. 


forty-six  buildings,  two  or  three  stories 
high.  These  buildings,  while  isolated 
above  ground,  are  all  connected  by  wide, 
well-lighted,  underground  corridors.  The 
bath-house,  while  far  removed  from  the 
medical  buildings,  serves  for  out  patient 


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FIG.  3.    GENERAL  PLAN,  BISPEBJERG  HOSPITAL,  COPEXHAGEX,  DENMARK. 
M.    Xyrop,   Architect. 


In  the  Barmbeck,  coupled  with  the 
medical  center,  is  the  patients'  entertain- 
ment hall,  which  is  used  also  for  a 
church.  On  the  surgical  side,  three  of  the 
pavilions  are  connected  by  corridors, 
while  the  fourth  is  isolated.  All  other 
buildings  throughout  the  group  are 
isolated. 

The  Bispehjerg  Hospital  of  Copen- 
hagen TFig.  3j,  designed  by  Professor 
Martin  Xyrop,  is  located  on  slightly  ris- 
ing ground.  The  site  is  ideal,  containing 
fifty-one  acres.     The  hospital  consists  of 


clinics  as  well  as  for  hospital  patients. 
The  grounds  are  laid  out  with  special 
care  for  the  comfort  of  the  patients,  with 
arbors,  benches,  and  fountains. 

One  of  the  most  modern  and  complete 
hospitals  in  Germany  is  Munich-Schzi'a- 
hing  (Tig.  4).  In  this  building  Archi- 
tect Richard  Schachner  has  embodied 
the  best  of  German  planning  and  coupled 
with  it  the  most  valuable  of  American 
ideas.  \A'hile  he  has  separate  pavilions, 
he  also  has  everywhere  connecting  corri- 
dors  above  ground,   except  to  the   con- 


THE  AMERICAN   HOSPITAi- 


1.  Main  building. 

2.  Chapel. 

3.  Sisters'  building. 

4.  Administration  building  and 

apothecary. 

5.  Benzine  building. 

6.  Operation  building. 

7.  Main  bath. 

8.  Kitchen. 

9.  Male  out-patients'  building. 
10.  Female  out-patients'  buildin: 

FIG.   4. 


11,  13,  Male  patients'  buildings.  23. 

12,  14.  Female  patients'  buildings.  24. 

15.  Disinfecting  building  and  laun-  25. 
dry.  26. 

16.  Garden  and  workshop.  27. 

17.  Machinery  building.  28. 

18.  Animal  experiment  building.  29. 

19.  Pathological  building. 

20.  Segregation  building.  30. 

21.  Contagion  building.  31. 

22.  Skin  and  sex  disease  building. 
GENERAL   PLAN,   MUNICH-SCHWABING   HOSPITAL, 

Richard    Schauchner,    Architect. 


Mental  disease  building. 
Children's  building. 
Gynecological  building. 
Janitors'  quarters. 
Director's  residence. 
Public  lavatory. 
Main  administration  building 

and  residence 
Coal  house. 
Building  for  help  of  electric 

plant. 
MUNICH,    GERMANY. 


tagious  and  special  treatment  buildings, 
and  between  these  there  are  underground 
passageways. 

The  administration  is  in  the  center, 
flanked  by  the  chapel  and  the  nurses'  resi- 
dence on  one  side  and  by  the  office  and 
the  home  for  the  staff  on  the  other.  The 
surgical  group  has  for  its  center  the  op- 
erating building ;  and  the  medical  unit,  a 
splendid  bath-house.  This  bath-house  is 
considered  the  finest  in  Europe  connected 
with  a  general  hospital,  and  will  be  de- 
scribed in  another  chapter. 

American  Hospitals.  The  Peter  Bent 
Brigham  Hospital  (Fig.  5),  created  by 
the  bequest  of  six  million  dollars  from 
the   man    for    whom   it    is    named,    was 


opened  in  1913.  In  the  year  1907  a  com- 
petition was  held  by  the  Trustees,  seven 
architects  being  invited  to  submit  plans, 
which  resulted  in  the  selection  of  Cod- 
man  &  Despradelle.  Perhaps  no  hospital 
in  America  has  had  more  study  and 
thought  put  into  it  than  has  this  institu- 
tion, and  the  plan  is  worthy  of  much 
study.  Under  the  guidance  of  the  super- 
intendent, Dr.  H.  B.  Howard,  the  archi- 
tects and  engineers  have  developed  a 
comprehensive  plan  which  gives  the 
patient  every  advantage  of  open  air,  sun- 
light, and  quick  and  quiet  service. 

In  planning  for  the  Cincinnati  General 
Hospital  (Fig.  6),  the  City  was  wise  in 
the  selection  of  a  site  which  would  give 


OF   THE   TWENTIETH    CENTURY 


THE  AMERICAN   HOSPITAL 


E    D    E.    /) 


A   V  E./1  U   E. 


PowEE.s.Ljv/iDa.Y  B'Lbi; 

er 


\j  iL  n  L  r 


A  V  E  /I  v;  e: 


CIN'CIXXATI    GENERAL    HOSPITAL.     GENERAL   PLAN. 


sufficient  room  for  growth.  It  was  also 
wise  in  its  appointment  of  Dr.  Christian 
R.  Holmes  as  medical  adviser,  since  the 
time  and  thought  he  has  given  to  this  in- 
stitution, after  studying  foreign  and 
American  hospitals,  has  made  it  one 
of  the  leading  hospitals  of  the  world.  Dr. 
Holmes  was  ably  assisted  by  the  archi- 
tects, Samuel  Hannaford  &  Son. 


The  trustees  of  the  Henry  Ford  Hos- 
pital, Detroit,  were  farseeing  in  the  se- 
lection of  their  site.  The  results  of  care- 
ful study  of  the  European  hospitals  are 
noticeable  in  their  plans,  made  by  Archi- 
tect William  B.  Stratton. 

The  plans  of  the  Toronto  General  Hos- 
pital, Toronto,  Canada,  were  developed 
through  a  term  of  years,  and  show  much 


OF   THE   TWENTIETH   CENTURY 


FIG.  7.     ST.   LUKE'S  HOSPITAL,  JACKSONVILLE,   FLA.     PLAN  OF  THE  GROUP. 


careful  study.  This  hospital  exhibits 
the  influence  of  the  English  institutions, 
particularly  in  the  surgical  units,  where 
each  unit  is  placed  under  the  charge  of 
one  surgeon,  who  has  his  own  operating 
rooms.  This  makes  of  every  unit  a  com- 
plete hospital. 

The  detached  buildings  of  many  of  the 
European  hospitals  seem  ideal  for  the 
climate  for  which  they  are  built ;  but  in 
America,  especially  in  the  rugged  climate 
of  the  northern  part,  protection  must  be 
given  the  patient  in  going  from  building 
to  building,  and  connecting  corridors,  at 
least,  are  generally  provided.  In  the 
mild  climate  of  Florida,  however,  at  St. 


Luke's  Hospital  (Fig.  7),  Jacksonville, 
it  has  been  possible  to  build  detached 
pavilions  with  open  corridor  connection. 
The  group  will  consist  of  fourteen 
buildings,  eight  of  which  are  finished  and 
occupied.  The  administration  building 
is  in  the  center,  with  the  ward  and  treat- 
ment buildings  to  the  south.  There  are 
six  or  eight  of  these  ward  and  treatment 
buildings,  only  two  being  now  built.  The 
domestic  building,  containing  kitchen 
and  dining-rooms,  is  directly  behind  the 
administration,  w^hile  the  power  house 
and  laundry  are  still  farther  back.  The 
nurses'  residence  occupies  a  position  cor- 
responding to  that  of  the  private  ward. 


10 


THE  AMERICAN   HOSPITAL 


Two  buildings  for  the  care  of  infectious 
diseases  are  also  provided. 

The  administration  building  contains 
not  only  the  offices  of  the  institution, 
but  also  the  accident  department,  the 
admitting  department,  and,  in  the 
second  story,  a  thoroughly  equipped 
operating  department  and  medical  treat- 
ment rooms. 

The  ward  unit  is  planned  to  eliminate, 


as  much  as  possible,  the  general  noise  of 
the  hospital,  and  to  give  an  abundance  of 
open-air  balconies.  The  private  ward 
unit  has  a  large  open-air  ward  on  the 
second  floor. 

The  isolation  building  is  so  planned 
that  patients  can  be  treated  individually, 
after  the  manner  of  the  Pasteur  Hospital 
at  Paris.  (See  description  in  Chapter 
VIII.) 


OF   THE   TWEXTIETH    CEXTURY 
CHAPTER    II. 


11 


ADMINISTRATION  DEPARTMENT. 


FIG.    8 


MA'^SACIH  '^EIT'^    OENPRM     HOSPIIAI 

(From    an    old    wood    cut.) 


Whether  it  is  a  large  institution  or  a 
hospital  of  twenty  beds  there  must  be 
headquarters  for  the  administrator  or  di- 
rector. This  department  may  vary  from 
a  single  room  to  a  vast  building  with  ad- 
mitting rooms,  waiting  rooms  and  staff 
rooms. 

From  careful  observation,  it  would 
seem  desirable  to  have  the  administrative 
unit  the  center  through  which  all  patients 
(except  stretcher  cases)  and  all  their 
friends  shall  pass,  and  where  the  general 
business  of  the  institution  shall  be  con- 
ducted. 

The  entrance  to  this  department  should 
be  carefully  studied  from  the  psychologi- 
cal standpoint,  with  reference  to  the  ef- 
fect on  the  would-be  patient.  It  should 
be  so  plainly  indicative  of  its  purpose 
that  there  can  be  no  hesitation  as  to  where 
to  go  first  for  further  direction.  The  in- 
formation desk  must  be  plainly  in  evi- 
dence and  at  this  desk  should  be  every 
facility  for  answering  questions. 

Waiting  space  should  be  provided  for 
visitors  who  may  come  in  numbers  be- 
fore the  visiting  hour.  There  should  be 
offices  of  the  superintendent,  admitting 
officer,  bookkeeper,  and  superintendent 
of  nurses;  the  staff  and  board  room,  and 
the  medical  library.  The  sleeping  and 
sitting  rooms  of  the  house  staff  and  in- 
ternes can  be  located  in  this  department 
building. 

In  the  smaller  hospital,  the  laboratories 
and  Roentgen-ray,  the  autopsy  and  lec- 
ture rooms,  and  at  times  the  kitchen  de- 


partment  work   out   most   satis- 
factorily in  this  unit. 

To  show  that  a  hospital  can  be 
successfully  run  without  a  so- 
called  administration  building,  it 
will  be  noted  that  the  Massachu- 
setts General  Hospital,  one  of 
the  oldest  in  the  country,  built 
by  Bulfinch  in  1821  (Fig.  8), 
did  not  have  an  administration 
building  until  1916;  so  that,  wnth 
the  hundred  years  in  which  to 
study  the  needs,  it  is  not  surpris- 
ing that  the  plan  is  well-nigh  per- 
fect (Figs.  9,  10). 

To  the  entering  visitor,  the  broad 
marble  information  counter  at  once  in- 
vites confidence ;  and  with  the  ample 
waiting-room  in  the  center  and  the  vari- 
ous offices  of  the  institution  around  the 
perimeter,  one  is  not  apt  to  lose  his 
way. 

The  plan  is  self-evident.  The  casualty 
entrance  from  the  same  court  comes  into 
the  basement  (Fig.  1),  where  there  are 
minor  operating  and  treatment  rooms.  In 
the  upper  stories  are  the  rooms  of  the 
staff". 

At  the  Peter  Bent  Brigham  Hospital 
fFig.  5),  the  problem  is  worked  out  on 
a  more  palatial  scale.  In  the  great 
rotunda  (Fig.  13),  the  circular  informa- 
tion deck  in  the  center  is  evidently  the 
center  of  information.  The  offices  of  the 
superintendent  and  his  assistants,  and 
that  of  the  superintendent  of  nurses,  as 
well  as  the  admitting  and  examining 
rooms,  are  grouped  around  the  rotunda. 
In  the  basement  are  located  the  Roent- 
een-ray  department  and  the  pharmacy. 
The  central  location  of  this  building,  con- 
necting as  it  does  the  approach  to  all  de- 
partments of  the  institution,  simpHfies 
the  problem  of  surveillance. 

At  the  Ohio  Valley  General  Hospital 
(Fig.  15),  which  is  a  block-type,  self- 
contained  building,  the  ground  and  first 
stories  are  set  aside  for  administration 
and  domestic  purposes.  The  main  and 
ambulance  entrances,  the  laboratories 
and    treatment    room,    the    out-patients' 


12 


THE  AMERICAN   HOSPITAL 


PLAN  OF  FIRST  FLOOR 

1  Main  entrance  to  Hospital 

2  Inionnation  office 

3  Stairs  to  public  toilet  for  men 

4  Waiting  room  for  patients  to  be  ad- 

mitted 
6,  6,  7,  8,  9,  10    Telephone  booths 

11  Admitting  Physician's  office 

12  Outside  corridor  to  yard 

13  Record  Clerks'  office 

14  Corridor  to  Main  Hospital 

15  Cashier's  office 

16  Elevator 

17  Bookkeeper's  vault 

18  Bookkeeper's  office 

19  Office    of    First    Assistant    Resident 

Physician 

20  Office  of  Resident  Physician 
21-   Trustees'  room 

22  Private  toilet 

23  Cleaners'  closet 

24  Clerks'  office 

25  Office  of  Superintendent  tsf  Nurses 

26  Office  of  Assistant  Superintendents  of 

Nurses 

27  Office  of  Assistant  Resident  Physicians 

28  Telephone  switchboard  room 
29,  30    Reception  rooms 

31  Office  of  Assistant  Resident  Physician 

32  Parcel  room 

33  Main  waiting  room  for  visitors 

34  Stairs  to  public  toilet  for  women 


FIG.  9.     MASSACHUSETTS  GENERAL  HOSPITAL.     PLAN  OF   FIRST  FLOOR, 
ADMINISTRATION  BUILDING. 

Coolidge    &   Shattuck,    Architects. 


FIG.    10.      MASSACHUSETTS    GENERAL    HOSPITAL.      EXTERIOR, 
ADMINISTRATION   BUILDING. 

Coolidge    &   Shattuck,    Architects. 


OF   THE   TWENTIETH   CENTURY 


13 


PLAN  OF  BASEMENT  FLoOR 

1    Corridor  to  ambulance  entrance 
.2    Isolation  room 

3     Dark  room 

4,  5,  6,  7, 11, 12    Operating  and  examining 
rooms 

8  Air  chamber 
•  9  Splint  room 
10    Covered    incline    to    possible    futxire 

buildings 
13    Ward  service  room 
14, 15     Male  and  female  emergency  wards 

16  Ward  kitchen 

17  Linen  room 

18  Blanket- warming  room 

19  Sterilizing  room 

20  Instrument  room  and  medicine  closet 

21  Storage  .vault 

22  Disinfecting  room 

23  Staff  dressing  room 

24  Tunnel  under  Fruit   St.,   to    Nurses* 

Home 

25  Women  employees'  rest  room 

26  Women  employees'  dressing  room 

27  Patients*  toilet  (women) 

28  Apparatus  room 

29  Public  toilet  for  women 

30  Storage 

31  Public  toilet  for  men 

32  Cleaners'  closet 

33  Patients'  toilet  (men) 

34  .Emergency- ward  bathroom 

35  Dressing  room  for  men  employees 

36  -Emergency- ward  office 

37  Entrance  for  ambulatory  patients 

38  Central  clothing  room 

39  Elevator. 


r '° 

■   i 

r 

h^. 

I 

' 

r^ 

1    ^ 

nnor 

A 

m^^fS^tOk 

t^J      L. 

i 

W^.  I. 

Lli 

(r^^ 


'U 


\\^\ 


fc 


0 


FIG.    11.    MASSACHUSETTS    GENERAL   HOSPITAL.      MOSELEY    MEMORIAL    (ADMINISTRATION) 

BUILDING. 
Coolidge   &  Shattuck,  Architects. 


and  isolation  rooms  are  on  the  ground 
jfloor  (Fig.  53),  while  the  main  adminis- 
trative offices,  the  internes'  quarters,  the 
kitchen  and  dining  rooms  are  on  the  first 


floor  (Fig.  17).  This  concentrates  all  of 
the  non-profit-bearing  portion  of  the 
building  near  the  ground  and  the  less  in- 
teresting- outlook. 


FIG.    13. 


PETER    BENT    BRIGHAM    HOSPITAL. 
VIEW   IN   ROTUNDA. 


FIG.    14. 


PETER    BENT    BRIGHAM    HOSPITAL. 
VIEW    OF    PHARMACY. 


14 


THE  AMERICAN   HOSPITAL 


OF  THE   TWENTIETH    CENTURY 


15 


,.  II  |i  l!  ^  If «.  *    fs    ?( 


«i 


t  it*'      ■  ■   ■ 


*;  .-4  2 


.'■3   3 


FIG.  15.    GENERAL  VIEW,  OHIO  VALLEY  GENERAL  HOSPITAL,  WHEELING,  W.  VA. 
Edward  F.   Stevens,  Architect. 


First     ruooE.    Puah 


FIG.  17.     PLAN  OF  FIRST  FLOOR,  OHIO  VALLEY  GENERAL  HOSPITAL,  WHEELING,  W.  VA. 

Edward   F.   Stevens,   Architect. 


16 


THE  AMERICAN   HOSPITAL 
CHAPTER  III. 

THE  WARD  UNIT. 


The  subject  of  the  ward  unit  has  been 
discussed  by  so  many  able  writers  on 
hospital  planning  that  one  hesitates  to 
say  more  on  the  topic ;  still,  the  ward 
unit  is  really  the  keynote  of  the  hospital, 
since  it  is  here  that  the  patient  for  whom 
the  institution  is  built,  lives,  eats,  sleeps, 
and  spends  his  weary  hours  of  conval- 
esence.  AA'e  should,  therefore,  never 
cease  to  study  the  best  methods  of  filling 
those  hours  with  as  much  comfort  as 
possible ;  how  to  serve  him  with  palatable 
food ;  how  to  provide  him  with  fresh  air 
and   sunshine;    and   how   to   guard   him 


from  undue  noise  and  from  the  excite- 
ment caused  by  the  workings  of  the  hos- 
pital. 

The  planning  of  the  ward  unit, 
whether  in  a  hospital  of  one  hundred  or 
one  thousand  beds,  presents  the  same 
problem — hozv  best  to  care  for  the 
patient.  After  more  or  less  careful  study 
of  hospital  buildings  in  Europe  and 
America,  after  consultation  with  many 
of  the  leading  hospital  authorities,  and 
after  living  in  the  hospital  and  seeing  the 
operation  and  treatment,  it  appears  to  the 
writer  that  there  are  certain  fundament- 


r 


'^ 


AMEULANCt      -POE-CH 


fLOOTJ.   Plan 


NfW   GENER-AL-  H0.5PITAL 
CINCINNATI    "     OHIO 

jAMUtL    H*NNflfOeD  ic  JONi  —  AU.CH1T£CTJ 

CiNCJNNATi  —  Ohio 


FIG.  18. 


OF   THE   TWENTIETH   CENTURY 


17 


als  which  every  ward  unit  should  pos- 
sess— i.e.,  every  ward  unit  of  a  general 
hospital  where  the  surgical,  the  usual 
medical,  and  special  cases  are  treated,  or 
where  the  general  run  of  cases  are  cared 
for.  These  essentials  of  planning  can 
be  classed  under  two  heads : 

(a)  Comfort  of  Patients.  The  com- 
fort and  care  of  the  patients  are  in- 
variably the  first  things  to  be  consid- 
ered. Around  this  center — the  pa- 
tient— we  build  our  institution.  If  the 
supplying  of  more  light,  better  air,  and 
freedom  from  disturbing  noises  will 
add  to  the  comfort  and  hasten  the  con- 
valescence of  the  patient,  then  these 
things  must  be  provided. 

(b)  Accessibility  of  Service.  The 
utility  rooms  should  be  so  near  and  so 
well  equipped  that  the  patient  need  not 
be  called  upon  to  wait  for  service.  At 
the  same  time,  these  service  rooms 
should  be  so  planned  that  the  necessary 
noises  therefrom  will  not  be  a  menace 
to  speedy  convalescence. 

The  ward  unit  should  be  planned  for 
the  particular  class  of  disease  which  is  to 
be  treated  in  it.  The  conditions  which 
govern  the  treatment  of  acute  surgical 
patients  are  different  from  those  govern- 
ing chronic  medical  cases.  The  ambula- 
tory tuberculosis  patient  needs  dift'erent 
accommodations  from  the  patient  suffer- 
ing with  the  same  disease  in  an  advanced 
form ;  the  child  from  the  adult ;  the  con- 
tagious  from  the  psychopathic  case. 

There  are  a  few  essentials  applicable 
to  all  classes  of  cases.  Whatever  the 
case  (with  a  possible  exception  of  eye 
cases),  the  ward  or  bed  of  the  patient 
should  be  so  placed  that  it  is  possible  to 
have  sunshine  in  the  room  and  near  the 
bed  some  part  of  the  day.  All  necessary 
inside  doors  and  all  doors  or  windows 
giving  access  to  porches  should  be  de- 
signed wide  enough  for  the  patient  to  be 
moved  in  his  bed  without  any  change  and 
without  any  discomfort  or  inconvenience, 
to  any  part  of  the  building,  porches,  or 
roof. 

As  to  the  number  of  beds  to  be  placed 
in  a  ward,  authorities  differ  very  much 
and  local  demands  vary  widely.  The 
best  authorities  abroad  believe  that  not 
more  than  sixteen,  or,  at  the  most,  eij'jh- 


teen  patients  should  be  in  one  room,  and 
some  think  that  these  should  be  sub- 
divided for  a  better  segregation. 

In  zvards,  every  patient  should  have, 
when  all  windows  and  doors  are  closed, 
at  least  one  thousand  cubic  feet  of  air. 
If  we  consider  the  height  of  the  ceiling 
twelve  feet,  each  patient  should  have  not 
less  than  eighty-three  square  feet  of  floor 
space — one  hundred  is  better.  The 
height  of  the  ceiling  may  depend  upon 
the  character  of  the  disease  being  treated, 
but  any  height  above  twelve  feet  is  un- 
necessary and  is  of  httle  use  in  the  puri- 
fication of  the  air,  since  the  breathing 
line  is  about  three  feet  from  the  floor. 
On  the  other  hand,  for  appearance's  sake, 
a  ward  of  more  than  ten  beds  should  not 
be  less  than  ten  feet  in  height. 

Where  wards  are  of  any  considerable 
size,  there  should  be  provided  nearby  one 
or  more  "quiet"  rooms  for  delirious  or 
dying  patients. 

Every  patient  should  have  at  least  semi- 
privacy  and  some  place  in  which  to  hide 
the  "household  gods"  which  he  may  have 
brought  with  him. 

Many  of  our  modern  hospitals,  for 
economy's  sake,  have  a  flat  roof ;  and 
some  of  them  use  this  roof  to  a  limited 
extent  for  the  care  and  treatment  of 
patients.  These  flat  roofs  should  be  used 
not  only  as  an  observatory  but,  if  partly 
covered  for  protection  from  storms  and 
intense  heat  and  partly  open  to  the  direct 
rays  of  the  sun,  a  patient  may  be  given 
open-air  treatment.  The  regular  ward 
service  of  toilet,  sink  room,  serving 
kitchen,  and  linen  and  supply  room 
should  be  provided  here. 

In  Europe  the  day  room,  or  conval- 
escent room  is  considered  by  the  Govern- 
ment so  important  that  every  hospital  is 
compelled  to  provide  one  for  each  ward 
or  group  of  private  rooms,  allowing  a 
little  over  nine  square  feet  for  each 
patient,  thus  making  the  area  of  the  day 
room  about  one-tenth  that  of  the  w^ard  or 
group  of  private  rooms.  In  some  institu- 
tions this  room  is  used  for  a  dining-room. 
The  day  room  for  wards  allows  a  separa- 
tion of  the  convalescing  patient  and  the 
really  sick  patient,  to  the  advantage  of 
each.  The  day  room  for  private  rooms 
affords  a  sitting  room  w-here  the  patients 


18 


THE  AMERICAN   HOSPITAL 


can  receive  their  friends,  gossip  one  with 
another,  and  get  away  from  the  mon- 
otony of  their  own  rooms. 

Every  ward  unit,  or  section  of  private 
rooms,  should  have  a  serving  kitchen  of 
sufficient  size,  so  placed  so  as  allow  quick 
service  of  palatable  food.  The  common 
faults  of  serving  kitchens  are  that  they 
are  too  small,  and  that  the  arrangement 
of  the  equipment  is  inconvenient.  Such 
rooms  should  be  carefully  planned  around 
the  equipment,  instead  of  the  equipment 
being  adapted  to  the  room  after  the  build- 
ing is  done.  The  things  most  used  should 
be  located  so  as  to  be  most  accessible ; 
and  the  things  which  are  needed  together 
should  be  adjacent,  in  order  to  save  time 
and  confusion.  There  should  be  facili- 
ties for  keeping  food  either  hot  or  cold ; 
for  cooking  small  diets ;  for  laying  trays 
for  patients,  and  for  washing  the  china. 
(See  Chapter  XVII,  on  "Equipment.") 

It  is  always  necessary  to  have  a  sep- 
arate utility  room  for  the  emptying,  ster- 
ilizing, and  storage  of  bed  pans  and  urin- 
als, and  such  service.  The  soiled  clothes' 
container  may  be  placed  here,  unless  a 
clothes'  chute  is  used.  Here,  also,  should 
be  the  gas  stove  for  the  making  of  poul- 
tices, the  sterilizer  for  boiling  instru- 
ments, the  ice-crusher  for  ice  caps,  the 
small  ice  storage  box,  the  blanket 
warmer,  etc.  A  local  incinerator  is  some- 
times found  valuable  for  destroying  ward 
waste,  and  can  be  placed  in  this  room. 

The  utility  room  and  the  serving 
kitchen,  on  account  of  their  constant  use, 
should  have  the  walls  tiled  to  at  least  four 
feet  in  height,  and  should  be  located  so 
as  to  minimize  annoyance  from  noises. 

Baths.  With  acute  cases  little  use  is 
made  of  the  bath  tub,  so  that  in  a  gen- 
eral surgical  or  medical  ward  only  a  lim- 
ited number  is  needed,  perhaps  one  to 
fifteen  or  twenty  patients. 

In  tubercular  wards,  simple  bathing 
facilities  should  be  provided,  both  tub 
and  shower,  since  bathing  usually  forms 
a  part  of  the  treatment. 

For  departments  where  patients  need 
assistance  in  taking  their  baths,  the  tub 
should  be  set  high  above  the  floor. 

In  children's  wards  where  the  bath  is 
always  given  by  a  nurse,  the  high,  shal- 


low slab  or  tub,  with  spray,  should  be 
used. 

For  the  ward  entrance  bath,  a  shallow 
tub  where  the  spray  can  be  used  has  been 
found  desirable.  (See  Chapter  XV,  on 
"Plumbing.") 

The  necessary  toilets  must  be  pro- 
vided. A  small  laboratory  is  a  great  con- 
venience. For  surgical  wards,  a  properly 
equipped  surgical  dressing  room  is  al- 
most a  necessity;  it  saves  much  dirt  and 
many  odors  in  the  ward,  and  adds  to  the 
comfort  of  other  patients. 

AVhere  there  are  many  private  patients, 
there  should  be  a  small  room  with  sink 
where  cut  flowers  can  be  taken  at  night 
and  rearranged  in  the  morning ;  this  pre- 
vents the  clutter  which  one  finds  in  the 
bath  or  sink  room  on  morning  rounds. 

For  the  convenience  of  doctors  and  at- 
tendants, lavatories  should  be  placed  in 
every  room  or  in  the  corridors  adjoining. 
Drinking  fountains,  preferably  of  the 
"bubbling"  type,  add  to  the  comfort  of 
both  patient  and  nurse. 

From  a  careful  investigation  of  mod- 
ern ward  units  for  the  care  of  general 
cases — of  eighteen  to  twenty-four  beds 
per  floor — -it  has  been  found  that  an  av- 
erage of  twenty-five  per  cent  of  the  area 
of  a  floor  is  needed  for  staircases,  ele- 
vators, and  utilities,  and  twenty-five  per 
cent  for  corridors,  leaving  fifty  per  cent 
for  patients.  Circumstances  will,  of 
course,  change  this  proportion.  In  con- 
tagious wards  the  proportion  for  utilities 
will  be  greater,  while  in  those  for  in- 
cipient tuberculosis  it  will  be  less. 

There  is  nothing  more  disturbing  to  a 
sick  patient  than  street  noises,  the  ring- 
ing of  electric  bells,  the  clatter  of  dishes, 
clicking  of  doors,  hum  of  conversation, 
the  flushing  of  plumbing,  etc.  He  wants 
quiet  and  grumbles  if  it  is  denied.  The 
minimizing  of  hospital  noises  is  one  of 
the  architect's  problems.  It  cannot  be 
accomplished  by  putting  legends  on  the 
wall,  warning  the  visitor,  doctor,  or  nurse 
to  "keep  silence."  It  must  be  done  by 
planning.  With  modern  fireproof  con- 
struction, hard-plaster  finish,  lack  of 
draperies,  and  necessary  elimination  of 
architectural  detail  the  very  walls  become 
sounding  boards,  which  transmit  and 
magnify  noises  throughout  the  building. 


OF   THE    TWENTIETH    CEXTURY 


19 


A  U. tit  3 


rOTUHC-  ; 


GRANT        JTT^ELT 


n  r 


PLOT  PLAN. 

BR[DGEPORT-IiO-5PITAL 

Bridgeport— -Conn 

LDWARP  E.5TiVtN3-AR.CMiTCCT 
5o_>TOM      Ma. 5^ 


FIG.   19. 


Hospitals  should  be  so  planned  that 
noises  are  confined,  as  far  as  possible 
to  the  localities  in  which  they  origin- 
ate. 

Much  elevator  and  staircase  noise  can 
be  avoided  if  these  are  enclosed  in  one 
shaft,  away  from  wards  or  private 
rooms,  witli  a  wide  landing-  in  front,  shut 
off  from  main  corridor  by  a  door. 

In  a  well-planned  private  house,  the 
kitchen  is  never  connected  with  the  liv- 
ing rooms  nor  directly  even  with  the  din- 
ing-room ;  yet  in  modern  hospitals  we 
sometimes  find  the  serving  kitchen  next 
to  or  directly  opposite  a  patient's  room 
or  ward,  with  the  clatter  of  dishes  dis- 
turbing him  many  times  a  day.  This  is 
also  quite  true  with  other  utility  rooms 
such  as  sink  room  or  public  toilets.  If 
these  utilities  can  be  segregated,  placed 
at  the  end,  the  center,  or  even  around  the 
corner  of  the  ward  building,  there  will 


be  much  greater  freedom  from  these  dis- 
turbing noises. 

In  maternity  departments,  the  nursery, 
the  delivery  room,  and  the  labor  room 
should  be  as  far  as  possible  from 
patients'  rooms,  and  should  be  isolated 
by  at  least  two  intermediate  doors.  ( See 
Chapter  \^I,  on  "Maternity  Depart- 
ment." j 

The  operating  department  should  be 
well  removed  from  all  others,  preferably 
on  a  separate  floor  or  in  a  separate 
pavilion. 

Floors  which  minimize  the  noise, 
either  of  cork  or  linoleum,  should  be 
used  in  the  sick  rooms ;  and  noiseless 
hardware  and  door  checks  to  prevent 
slamming,  etc.,  should  be  considered  in 
the  construction  of  the  building. 

Outside  noises,  such  as  street  cars, 
railroads,  traffic  on  the  pavement,  manu- 
facturing plants  in  the  vicinity,  etc.,  can 


20 


THE  AMERICAN   HOSPITAL 


be  avoided  only  by  proper  location.    This  to     illustrate     some     of     the    important 

should  receive  serious  consideration.  points. 

A  few  examples  of  both  the  European  europeax  ward  uxits. 

and  the  American  ward  units  will  serve  It  will  be  noticed  that  in  the  Bannheck 


k^     _ 


^*- 


S         B 


'TV  .V 


'W'^r   v^#  *:.>^ 


•  .'■-  -l^-l 


OF   THE    TWENTIETH   CENTURY 


21 


'OO / V y  ao 


;t=^A^ 


^  ^ 


p 

-fa 

o 

< 


the  largest  ward  is  sixteen  beds  ( Fig. 
2)  ;  that  from  each  ward  is  a  liegehalle 
or  airing  balcony ;  that  each  ward  has  its 
tageranrfyi  or  day  room ;  that  the  serving 
kitchen,  sink  rooms,  and  toilets  are  re- 
moved from  the  vicinity  of  the  patients' 
rooms ;  and  that  each  ward  unit  has  a 
laboratory  and  a  surgical  dressing  room. 
This  ward  building  proper  is  two  stories 
in  height,  with  room  on  the  third  floor 
for  a  few  nurses  for  quick  call. 

The  operating  building  of  this  hospital 
of  fifteen  hundred  beds  has  but  two  op- 
erating rooms,  so  that  many  of  the  minor 
surgical  procedures  are  done  in  the  surgi- 
cal dressing  rooms  which  are  in  each  unit. 
The  Barmbeck  unit  is  an  unusually  good 
and  complete  one. 

The  Rigs  Hospital  ward  unit  f  Fig.  21) 
has  much  to  commend  it  as  worthy  of 
study,  for  it  is  in  many  ways  unique. 
The  staircase,  elevator,  and  other  noisy 
equipment  are  kept  at  the  extreme  ends, 
away  from  the  portion  of  the  building 
occupied  by  patients.  The  serving 
kitchen,  bath  and  sink  rooms  are  on  a 
cross  corridor;  the  surgical  dressing 
rooms  and  toilets  are  at  the  opposite  end 
of  the  building.  An  isolation  room  and 
nurses'  room  are  placed  in  the  center. 

The  ward  itself,  containing  twenty-six 
beds,  is  divided  into  eight  sections,  each 
section  containing  three  or  four  beds.  A 
dividing  screen  afifords  privacy  to  the 
patients  and  still  allows  free  access  to 
all  parts  of  the  room  for  the  atten- 
dants. The  screens,  only  six  feet  high 
and  raised  one  foot  from  the  floor,  afford 
the  same  ventilation  as  an  open  ward. 
Bowls  for  surgeons'  use  and  medicine 
closets  are  placed  in  each  ward. 

This  is  doubtless  one  of  the  best  de- 
veloped ward  units  in  Europe. 

In  the  Bispehjerg  Hospital  (Fig.  23), 
the  ward  unit  is  interesting,  sixteen  beds 
being  the  largest  ward.  The  entire  de- 
sign of  the  group  is  simple  and  dignified, 
and  rather  dififerent  from  the  stereotyped 
styles  one  sees  throughout  Germany. 
Professor  Nyrop  has  taken  advantage  of 
the  natural  contour  of  the  land  in  the  use 
of  terraces,  steps,  and  landscape  efifects. 

The  details  of  the  various  equipment 
were  very  carefully  devised. 

In   the   Miinich-Sclrivahiug    (Fig.   24) 


22 


THE  AMERICAN   HOSPITAL 


FIG.  21.    PLAX  OF  WARD  UNIT— RIGS  HOSPITAL,  COPEXHAGEX,  DEXMARK. 


unit  the  largest  ward  is  twelve  beds.  All 
wards  face  the  south  and  have  oppor- 
tunities for  wheeling  patients  into  the 
balconies  and  into  the  gardens.  The  bal- 
conies are  spacious  and  comfortable  with 
attractive  boxes  of  flowers  decorating 
them  in  summer.  The  service  rooms  are 
to  the  north,  also  the  laboratory  and 
dressing  rooms.  The  day  room  is  to  the 
south,  central  with  the  unit. 


FIG. 


23.    BISPEBJERG   h5SPITAL,    WARD   UXIT. 
M.    Xyrop,    Architect. 


The  admitting  department  for  each 
ward  unit  is  very  complete.  The  patient 
comes  into  room  Xo.  11 ;  his  clothes  are 
removed  and  put  into  a  container  of  linen 
which  is  hung  on  a  truck ;  he  next  goes  to 
room  No.  12,  where  he  is  bathed ;  to  No. 
13,  where  he  is  given  hospital  clothes ; 
passes  to  No.  8,  where  final  examination 
is  made  and  history  completed,  and 
thence  to  his  bed.  The  elevator  at  this 
part  of  the  building  is  for  the  convenience 
of  the  second-story  patients. 

AMERICAX'    WARD    UX'ITS. 

The  European  hospitals  are  built  and 
supported  very  largely  by  the  govern- 
ments. In  this  country,  we  have  a  very 
different  condition.  Many  of  our  hos- 
pitals are  private  corporations,  and  it  is 
generally  a  question  of  accommodating 
the  largest  number  of  patients  for  the 
smallest  amount  of  monev.     Our  archi- 


tects, therefore,  are  often  forced  to  econ- 
omize in  every  way,  until  the  wards  in 
many  cases  have  become  almost  barracks 
for  the  mere  housing  of  people,  and  the 
attendants  are  obliged  to  put  up  with  the 
scantiest  accommodations. 

Some  of  our  newer  hospitals  are  ris- 
ing in  scale.  Instead  of  making  a  num- 
ber of  rooms  and  leaving  it  to  the  admin- 
istrator to  find  out  later  what  he  can  put 
into  these  rooms,  the}-  are  allowing  their 
architects  to  provide  some  of  the  more 
essential  rooms,  such  as  the  sink  room, 
a  ser^'ing  kitchen  of  sufficient  size,  a  surg- 
ical dressing  room,  laboratory,  etc. ;  and 
are  letting  him  design  and  plan  the  equip- 
ment at  the  time  he  makes  the  drawings 
for  the  building. 

The  care  and  thought  put  upon  the 
working  out  of  the  plan  of  the  Peter 
Bent  Brigham  Hospital  (Figs.  25-27), 
makes  it  worthy  of  attention. 

The  first  floor  of  the  ward  unit  con- 
tains two  large  wards,  one  of  eight  and 
the  other  of  fourteen  beds.  A  cross  cor- 
ridor separates  the  two  wards.  Two 
isolation  rooms,  with  diet  kitchen,  duty 
room,  baths  and  toilets,  are  grouped  to- 
gether on  the  side  of  the  corridor  op- 
posite the  main  ward.  There  are,  also, 
a  laboratory  and  a  consultation  room  on 
this  floor. 

The  staircase  and  elevator  lead  direct- 
Iv  from  the  main  corridor  at  the  extreme 
north  end  of  the  building. 

In  the  second  story  there  is  one  large 
ward  of  twelve  beds,  two  isolation  rooms, 
duty  and  toilet  rooms.  Ample  airing  bal- 
conies or  terraces  on  both  floors  provide 
outdoor  space  for  all  the  patients  of  this 
unit. 


OF   THE   TWENTIETH   CENTURY 


23 


!   i 


24 


THE  AMERICAN   HOSPITAL 
Typical  Pavilion 


FIGS.  25,  26  AND  27.    FLOOR  PLANS,  WARD  UNIT,  PETER  BENT  BRIGHAM  HOSPITAL,  BOSTON. 

Codman   &  Despradelle,   Architects. 


OF  THE   TWENTIETH    CENTURY 


25 


FIG.  28.    INTERIOR  PAVILION  "C,"   PETER  BENT   BRIGHAM  HOSPITAL,   BOSTON,   MASS. 
Codman   &  Despradelle,   Architects. 


FIG.  29.  INTERIOR  OF  WARD,  PAVILION  "C,"  PETER  BENT  BRIGHAM  HOSPITAL,  BOSTON,  MASS. 

Codman    &  Despradelle,   Architects. 


26 


THE  AMERICAN   HOSPITAL 


FIG.  30.    AIRING  BALCONY,  PAVILION  "C,"  PETER  BENT  BRIGHAM  HOSPITAL.  BOSTON,  MASS. 

Codman  &  Despradelle,  Architects. 


The  portion  of  the  building  containing 
the  octagonal  ward  (Fig.  28)  is  but  one 
story  in  height,  and  has  monitor  win- 
dows. The  main  ward,  second  story 
(Fig.  29),  is  also  top-lighted. 

On  the  third  floor  (Fig.  27),  there  is 
an  open-air  ward,  with  the  necessary 
duty  room,  toilet,  and  isolation  rooms. 
This  can  also  be  used  for  contagious 
cases  which  may  develop  in  the  hospital. 

The  Cincinnati  General  Hospital  shows 


the  influence  of  European  examples.  Dr. 
Holmes  has  given  much  thought  to  the 
perfecting  of  this  ward  unit  (Figs.  31- 
34). 

In  this  ward  unit  the  nurses'  station, 
while  not  directly  in  the  main  ward,  is  in 
such  a  position  that  it  commands  a  view 
of  all  the  ward  beds,  as  well  as  the  doors 
of  the  private  rooms. 

The  patients'  toilet  is  entered  through 
a  fresh-air  cut-off,  after  the  manner  of 


FIG.  31.    WARD  UNIT  PLAN-NEW  GENERAL  HOSPITAL,   CINCINNATI,  OHIO. 
Samuel   Hannaford   &   Sons,   Architects. 


OF   THE   TWENTIETH   CENTURY 


27 


FIG.  32.    INTERIOR  OF  ONE  OF  THE  WARD  BUILDINGS-NEW  GENERAL  HOSPITAL, 

CINCINNATI,  OHIO. 
Samuel  Hannaford   &  Sons,   Architects. 


the  best-planned  English  hospitals.  The 
sink  room  is  entered  either  through  the 
nurses'  work  room  or  directly  from  the 
corridor.  There  are  additional  toilet 
facilities  connected  with  the  solarium, 
thus  minimizing  the  work  of  nurses  or 
attendants. 

The  utilities,  baths,  and  toilets  are 
grouped  together.  The  entrance  to  the 
serving  kitchen  is  near  the  main  stair  and 
elevator  corridor.  A  commodious  dining 
room  is  provided  for  those  patients  who 
are  able  to  be  about. 

In  the  Henry  Ford  Hospital  (Fig.  35), 
the  ward  unit  provides  for  sixteen  beds 
in  the  general  ward,  one  two-bed  ward 
and  two  single  rooms.  The  patients' 
toilet  is  entered  indirectly  from  the  ward 
through  a  fresh  air  passage.  There  are 
also  additional  toilets,  entered  from  the 
solarium  or  day  room. 

In  the  six-story  building  recently 
erected  for  the  Harper  Hospital  (Figs. 
36  and  ?>?) ,  Detroit,  an  innovation  has 
been  introduced  into  the  construction  by 
making  eight-foot  set-backs  in  the  walls 
of  the  main  pavilion  at  the  fourth  floor  so 


that  the  first  three  stories  provide  for  pri- 
vate rooms  on  either  side  of  a  wide  cor- 
ridor. The  upper  three  stories  provide 
for  a  ward  on  each  of  proper  width  for 
administration.  This  allows  for  two  large 
airing  balconies  on  the  fourth  floor,  over 
the  roof  of  the  third-story  private  rooms. 

In  this  plan,  also,  the  utilities  are 
grouped  in  the  center,  with  a  fresh  air 
cut-off  between  them  and  the  main 
twenty-two-bed  ward.  At  the  end  of  the 
large  wards  toilet  rooms  are  provided,  in 
addition  to  the  general  toilet  rooms  from 
the  main  corridor. 

For  every  story  there  are  surgical 
dressing  rooms,  and  on  the  private  room 
floors  a  special  room  for  cut  flowers  is 
introduced.  The  seventh  story  consists  of 
a  large  roof  ward,  with  diet  kitchen  and 
other  utilities. 

In  the  St.  Luke's  Hospital,  Jackson- 
ville. Fla.,  it  was  planned  to  have  several 
public  Avard  units  (Fig.  40),  accommo- 
dating thirty-six  patients  in  each  build- 
ing, the  largest  ward  containing  but  six 
beds.  The  entrance  is  from  the  open-air 
corridor  at  the  east,  and  the  utility  rooms 


28 


THE  AMERICAX   HOSPITAL 


?^IiC^-  "^"'^^i 


iUMJlifll 


in 


FIG  33.     WARD   BUILDINGS    -C"   AND    "B- — XEW    GENERAL   HOSPITAL,    CINCINNATI,    OHIO. 
Samuel  Hannaford   &  Sons,  Architects. 


FIG.  34.    REAR  VIEW,  WARD  BUILDINl,.-     J     AND  -K'-NEW  GENERAL  HOSPITAL, 

CINCINNATI,   OHIO. 
Samuel  Hannaford   &   Sons,   Architects. 


OF  THE   TWENTIETH   CENTURY 


29 


F12.5T    TLODE.    PLAN 


•  PEIVATE-PATIENT'&UILDINQ  ' 
HENRY-  rOED'  HOSPITAL- PETEOIT-  MICH 


1.  Operating  Room.  2.  Sterilizing  Room.  3.  Operating  Amphitlieater.  4.  Nurses'  Work  Room.  5. 
Emergency  Operating  Room.  6.  Passage.  7.  Doctors'  Wash  Room.  8.  Anesthetizing  Room.  9.  Dark 
Operating  Room.  10.  Utility  Room.  11.  Emergency  Receiving  Room.  12.  Laboratory.  13.  Doctors' 
Phone.  14.  Doctors'  Offices.  15.  Rear  Entrance.  16.  Doctors'  Locker  Room.  17.  Toilet  Room.  18. 
Waiting  Room.  19.  Accounting  Room.  20.  Phone  Exchange.  21.  Office.  22.  Private  Room.  23.  Bath. 
24.  Alcove.  25.  Linen.  26.  Utility.  27.  Diet  Kitchen.  28.  Dressing  Room.  29.  Head  Nurse.  30.  Doctors' 
Phone. 


30 


THE  AMERICAN   HOSPITAL 


Harplr    Hojpttal 


MALCOMJON    ($c  HlGGINBOTHAn 
Architlctj 
R.OIT  Michigan. 

LDWARD   F   JTLVE.NJ 


FIG.    36.    HARPER    HOSPITAL.    HUDSON    MEMORIAL,    DETROIT,    MICH. 
Malcomson  &  Higginbotham,  Architects,  Detroit,  Mich. 
Edward  F.  Stevens,  Consulting  Architect,  Boston,  Mass. 


are  grouped  around  this  entrance,  with 
the  doors  to  sink  room,  serving  kitchen, 
nurses'  toilet,  and  elevator  opening  from 
the  cross  corridor,  minimizing  the  noises 
from  these  disturbing  elements.  Two 
large  airing  balconies  are  provided  on 
each  floor. 

In  the  private  pavilion  of  the  same  hos- 
pital (Fig.  38)  a  similar  arrangement  is 
secured  so  far  as  the  utilities  are  con- 
cerned. The  units  are  smaller,  a  three- 
bed  ward  being  the  largest,  most  of  the 
space  is  utilized  for  single  rooms.  In 
this  plan,  the  open-air  ward  is  introduced 
on  the  second  floor,  being  connected  with 


the  main  corridor  and  served  from  the 
main  utility  rooms.  Both  this  building 
and  the  public  ward  unit  are  but  two 
stories  in  height. 

In  the  Youngstown  Hospital  at 
Youngstown,  Ohio,  the  ward  unit  (Figs. 
42  and  43)  is  not  unlike  some  of  the 
others  described,  providing  for  a  central 
location  of  the  utilities,  with  suflicient 
isolation  for  the  rooms  and  wards  to  min- 
imize the  effect  of  noises  upon  the 
patients. 

The  first  floor  of  this  pavilion  is  used 
only  for  ward  patients ;  and  the  second, 
third,  and  fourth  floors  for  private  pa- 


nDDDDD 

DDDnDD 

,DDDDD  %^\ 

4Q,  £  A  i 


FIG.  37.    HARPER  HOSPITAL.    HUDSON  MEMORIAL. 


OF   THE   TWENTIETH   CENTURY 


31 


o. 

-I 


tients.  On  the  north  there  is  a  day  room 
on  each  floor,  and  a  large  roof  ward  on 
the  fifth  floor. 

The  ward  unit  used  in  the  maternity 
and  children's  department  of  the  Bridge- 
port Hospital  at  Bridgeport,  Conn.,  is 
one  which  will  apply  to  any  general  ward 


(  Fig.  44),  and  is  described  under  the 
chapters  on  maternity  and  children's  hos- 
pitals.    (See  also  Figs.  45-49.) 

This  unit,  designed  on  the  Rigs  Hos- 
pital ward  plan,  aft'ords  a  better  division 
of  patients  than  almost  any  other  plan  of 
the  same  area.     It  is  arranged  in  groups 


32 


THE  AMERICAN  HOSPITAL 


FIG.  39.    VIEW  OF  PRIVATE  WARD  BUILDIKG-ST.  LUKE'S  HOSPITAL,  JACKSONVILLE,  FLA. 
Ei^ward   F.   Stevens,   Architect;   Mellen   C.    Greeley,   Associate   Architect. 


of  four  beds,  allowing  one  large  window 
for  each  group.  The  division  between 
the  groups  is  made  by  a  permanent 
screen,  upon  which  are  placed  the  con- 
nections for  the  nurses'  calls  and  the 
electric  lights. 

The  utilities  and  quiet  room  are 
planned  for  the  most  efficient  service. 

The  Gallozvay  Memorial  Hospital  a! 
Nashville,  Tenn.  (Fig.  50),  consists  of  a 
group  of  three  buildings,  the  first  one  to 
be  erected  being  in  the  center,  and  is 
composed  of  an  operating  pavilion,  char- 
ity ward  pavilion,  and  private  ward 
pavilion. 

In  the  operating  pavilion  the  basement 
floor  is  to  be  used  for  administrative  pur- 
poses and  to  the  rear  an  ambulance  porch 
shelters  patients  being  received.  The 
second  floor  consists  of  the  operating  de- 
partment, together  with  dressing  rooms, 
sterilizing,  anaesthetic  and  recovery 
rooms,  and  all  other  modern  arrange- 
ments necessary  to  a  thoroughly  equipped 
operating  department.  The  third  floor  is 
similarly  fitted  for  a  charity  operating 
department,   and    is    furnished   in   every 


particular  with  the  same  conveniences 
and  advantages  that  the  pay  service  will 
afford. 

Ward  D  is  for  charity  patients  only. 
The  basement  floors  are  used  for  con- 
sultation, emergency  beds  and  a  free  dis- 
pensary. The  second  and  third  floors 
hold  one  hundred  charity  beds,  con- 
veniently arranged,  with  one  to  twelve 
beds  per  room.  The  roof  garden,  to 
which  the  patients  have  access  for  fresh 
air  and  sunshine,  is  reached  by  an  ele- 
vator. 

In  Ward  B,  the  basement  floor  for  the 
present  will  furnish  space  for  kitchen, 
dining-rooms  and  domestic  service.  The 
second  and  third  stories  contain  thirty- 
two  rooms  for  pay  service  ;  and  the  fourth 
floor,  in  the  form  of  a  roof  garden,  fur- 
nishes outing  space,  sunshine  and  fresh 
air  for  the  patients  below  and  can  be 
reached  by  means  of  an  elevator  from  the 
wards. 

In  the  German  Hospital  in  Chicago 
(Figs.  51  and  52),  which  is  of  the  L- 
shape  plan,  the  architects  have  designed 
the  private  and  public  wards  in  dift'erent 


OF  THE  TWENTIETH  CENTURY 


33 


sections  of  each  floor,  giving  an  excellent 
chance  for  segregation  and  treatment  of 
diseases.  In  the  public  ward  portion,  six- 
bed  wards  are  the  largest.  The  placing 
of  the  elevator  and  staircase  in  a  sep- 
arate space,  and  grouping  about  these  the 
utility  rooms,  must  tend  to  minimize  dis- 
turbance from  the  noises.  Each  floor  is 
provided  with  two  suites,  with  bath  and 
toilet  connecting,  so  arranged,  however, 
that  the  waterclosets  and  bowls  are  sep- 


arated from  the  tub,  making  it  possible 
to  use  the  suites  as  private  rooms.  The 
maternity  and  operating  departments  are 
on  the  fourth  floor,  with  proper  shut-offs 
and  segregation  of  the  noisy  portions  of 
the  maternity  department. 

The  Ohio  Valley  General  Hospital 
(Fig.  53)  was  built  on  one  of  the  many 
hills  of  West  Virginia,  which  made  it 
necessary  to  utilize  the  various  grades  of 
the  streets  surrounding  the  site.  An  al- 
most precipitous  cliff  at  the  north  deter- 
mined the  outline  of  the  north  wing. 

The  hospital  is  a  block  type,  self-con- 
tained institution.  It  is  planned  to  care 
for  all  departments  of  a  general  hos- 
pital— out-patient,  accident,  surgical, 
medical,  maternity,  children's,  con- 
tagious— as  well  as  for  the  segregation 
of  colored  patients.  It  is  also  provided 
with  heating,  lighting,  and  refrigerating 
plants,  as  well  as  a  distilling  plant  for 
distilling  all  the  drinking  water  and  that 
used  in  connection  with  the  surgical  de- 
partments. 

In  planning  this  institution,  it  was  de- 
cided to  have  no  wards  larger  than  eight 
beds,  as  a  better  segregation  of  cases 
could  be  obtained  than  by  using  large 
wards.  This  being  a  general  hospital, 
both  private  and  charity  cases  are  cared 
for. 

Provision  is  made  on  every  floor  for 
airing  balconies  (Fig.  54)  so  that  all 
patients  can  be  wheeled  into  the  open 
when  desired.  A  large  roof  ward  is  pro- 
vided on  the  upper  story. 

The  combining  of  the  contagious  de- 
partment (Fig.  158)  with  the  general 
hospital  within  the  same  walls  is  prac- 
ticed here  without  any  serious  complica- 
tions or  cross  infections. 

The  Macon  Hospital  (Fig.  55)  like 
many  another  institution  throughout  the 
United  States,  found  that  its  work  was 
deficient  on  account  of  lack  of  better 
facilities  for  the  care  of  the  sick ;  addi- 
tional land  was  secured  in  two  different 
directions  and  the  development  of  the  in- 
stitution has  been  attempted.  The  old 
buildings,  A,  B,  and  C,  have  been  re- 
modelled and  put  into  working  condition. 
The  ward  unit  in  Building  B  has  been 
rearranged  on  the  "Rigs"  type,  provid- 
ing for  sixteen  beds,  with  quiet  rooms 


34 


THE  AMERICAN  HOSPITAL 


il»r 


FIG.  41.    ST.   LUKE'S  HOSPITAL,   JACKSOXVILLE.     CORRIDOR  AND   PUBLIC  WARD  UNIT. 


and  utilities,  while  the  old  children's 
ward  has  been  made  into  a  modern  serv- 
ing kitchen.  The  old  staircases  and  gen- 
eral partitions  in  A,  B,  and  C  have  been 
largely  retained,  but  the  utilities  have 
been  enlarged. 

Pavilions  D,  E,  and  F  are  new. 
Pavilion  D  is  practically  for  private  pa- 
tients and  consists  of  private  rooms  and 
the  general  utilities.  Pavilion  F  is  de- 
signed for  colored  patients,  who  in 
southern  sections,  of  course,  must  be 
segregated  from  the  white  patients.  The 
service  building,  E,  contains  the  kitchen, 
dining-room,  laundry,  power  plant,  and 
garage,  and  is  located  centrally  with 
respect  to  the  whole  group. 

The  ground  floor  of  the  pavilion  for 
negroes,  F,  is  devoted  to  an  out-patient 
department,  which  will  be  described  in 
another  chapter. 

The  third  floor  of  Pavilion  D  consists 
of  children's  and  operating  departments, 
which  are  described  in  their  proper 
places.  The  roof  ward  (Fig.  56)  is  pro- 
vided with  ample  facilities  for  out-door 
treatment,  and  is  connected  directly  with 
the  serving  kitchen,  elevator,  and  stair- 
case. 

The  Mansfield  General  Hospital,  at 
Mansfield,  O.,   (Fig.  57)   is  another  ex- 


ample of  the  self-contained  type,  with  all 
departments  in  one  building.  In  this  hos- 
pital the  attempt  has  been  made  to  segre- 
gate, so  far  as  possible,  the  divisions  of 
male,  female,  children's  and  maternity; 
and  with  the  T-shape  plan  which  is  here 
adopted  this  was  found  to  be  a  compara- 
tively easy  problem  to  solve.  A  central 
serving  kitchen  serves  all  of  the  three  dif- 
ferent departments  on  each  floor.  A  sep- 
arate sink  and  toilet  room,  however,  is 
provided  in  each  unit.  The  nurses'  sta- 
tion is  located  in  the  center,  from  which 
point  it  is  possible  to  observe  the  three 
wings  of  the  building.  The  main  offices 
are  located  on  the  first  floor ;  and  a  small 
out-patient  department,  a  medical  treat- 
ment. Roentgen-ray  department,  the  heat- 
ing plant  and  the  kitchen  plant  are  located 
on  the  ground  floor.  The  contour  of  the 
site  selected  allows  for  good  lighting  in 
all  departments. 

On  the  second  floor  TFig.  58)  are 
located  the  maternity  department  and 
private  rooms  and  suites ;  and  shut 
off  and  isolated  from  the  rest  of  the 
building  is  the  operating  department. 
The  maternity  delivery  room  is  placed 
within  the  operating  section,  making  it 
possible  to  utilize  the  sterilizing  room,  the 
doctors'    waiting-room,    and    the    other 


OF  THE  TWENTIETH   CENTURY 


35 


FIG.  42.    YOUNGSTOWN  HOSPITAL,  TOD  WING. 


FIG   43.    YOUNGSTOWX   HOSPITAL,    TOD    WING.    TYPICAL   FLOOR    PLAN. 


equipment  of  the  operating  department 
in  connection  with  the  obsetetrical  work. 
The  recent  addition  to  the  Hamot  Hos- 
pital, at  Erie,  Penn.,  consists  of  a  seven- 
story  fireproof  building  (Fig.  60)  which 
is  devoted  largely  to  private  rooms  and 
surgical  department  of  the  hospital.  This 
pavilion  is  designed  as  the  first  unit  of  an 
entirely  new  Hamot  Hospital,  but  is  com- 
plete in  itself.  In  this  ward  unit,  all  the 
utilities  are  grouped  at  one  end  of  the 
building;  the  stair  hall  and  elevator  are 
shut  ofif  from  the  main  corridor ;  the  sink 
room  and  serving  kitchen  are  at  the  ex- 
treme end  of  the  building.  A  large 
solarium  and  airing  balcon}^  are  on  the 
southwest  end  of  the  building  on  each 
floor.    Fig.  59  shows  a  typical  floor. 


In  the  San  Francisco  Hospital  (Fig. 
61),  the  ward  unit  has  some  interesting 
features.  The  main  ward,  while  rather 
larger  than  some  authorities  would: 
naturally  permit,  is  well-lighted  and  ven- 
tilated. The  architect  has  introduced 
into  this  ward  unit  the  old  English  toilet 
tower  which,  while  having  excellent 
hygienic  reasons  for  its  existence,  has  a 
tendency  to  darken  more  of  the  main 
ward  than  if  the  toilet  were  placed  at 
either  end  of  the  long  ward.  While  the 
toilet  tower  up  to  within  a  few  years  was 
used  very  generally  in  all  English  hos- 
pitals, some  of  the  best  English  authori- 
ties today  are  not  advocating  it. 

The  utilities  of  this  ward  unit  are  ex- 
cellently   arranged.    The    splendid    day 


36 


THE  AMERICAN  HOSPITAL 


room  for  patients,  away  from  the  ward 
unit  itself,  is  most  attractive.  Each  unit 
has  its  own  surgical  dressing  room  and 
its  own  laboratory,  as  well  as  the  quiet 
rooms  and  necessary  toilets. 

In  the  Illinois  Central  R.  R.  Hospital, 
Chicago,  the  ward  unit  is  somewhat  un- 
usual, as  there  are  no  large  wards.  The 
greatest  number  of  beds  in  any  ward  is 
four,  while  the  majority  of  the  rooms  are 
for  individual  patients. 

Like  some  of  the  other  hospitals  de- 
scribed, the  basement  and  first  floor  are 


small  out-patient  department,  with  wait- 
ing and  treatment  rooms ;  also  rooms  for 
the  internes  and  chief  surgeon. 

The  kitchen,  scullery,  diet  kitchen,  dis- 
infecting room,  mortuary,  etc.,  are  lo- 
cated in  the  basement. 

The  ward  utilities  are  sufficiently  iso- 
lated from  the  public  corridor.  The  ele- 
vator and  staircase-hall  are  placed  in  a 
separate  tower. 

On  the  third  floor  (Fig.  63)  is  located 
the  operating  suite,  consisting  of  three 
operating    rooms,    nurses'    work    room, 


Maternity  Pavilion 
Bridge POR.T  Hospital 
Bfudgepoiu       Conn 

C.DWftE.DF.5TEVEN:5     AR.CH1TCCT 
Bottom    MAii 


FIG.    44.    PLAN   OF    FIRST    FLOOR— MATERNITY    BUILDING,    BRIDGEPORT    (CONN.)    HOSPITAL. 

Edward   F.   Stevens,  Architect. 


devoted  to  administration  and  medical 
treatment,  and  there  are  no  patients' 
rooms  below  the  second  floor.  The  en- 
trance lobby  is  large  and  generous,  giv- 
ing the  would-be  patient  the  idea  of  hos- 
pitality. 

On  the  first  floor  (Fig.  62),  besides 
the  general  office,  reception  rooms,  etc., 
are  located  the  laboratory,  the  hydro- 
therapeutic,  Zander  room,  and  X-ray 
room,  together  with  rest  room,  toilets, 
etc.,  for  the  medical  treatment  depart- 
ment.     On  this   floor   is   also   located   a 


sterilizing  room,  anaesthetizing  room, 
utility  room,  and  surgeons'  locker  room, 
the  surgeons'  scrub-up  being  placed  at 
the  end  of  the  main  operating  corridor. 
Built-in  cabinets,  blanket  warmers,  etc., 
make  this  a  most  complete  unit. 

The  heating  plant  and  laundry  are  in 
an   entirely   separate   building. 

The  demand  for  a  private  ward  unit  in 
Canada's  great  hospital,  the  Royal  Vic- 
toria, in  Montreal,  has  been  so  great  that 
one  of  her  most  generous-hearted  sons 
has   provided  the  means   for  building  a 


OF  THE  TWENTIETH  CENTURY 


37 


5.C 


or 


3EC0ND  fLOOt  PLAN 

iCALE  -  '■'  ■'  '■' W  V  V  •■'«'•  if  rEEt 
E 
N.— '-O "'-^ 


Maternity  pavilion 

Bridgeport  Hospital 
Brjdgeport       Conn 

EDV/At.D  f.  JtEVENJ     At-CHITCCT 
Boston  MA5j 


FIG.  45.    PLAN  OF  SECOND  FLOOR— MATERNITY  BUILDING,  BRIDGEPORT   (CONN.)   HOSPITAL. 

Edward  F.  Stevens,  Architect. 


MATERNITY  PAVILION 
Bridgeport  HoiPiTAL 
Bridgeport        Conn 

EDV/ftft-D  f  .iTEVENi     AtLCniTECT 

BojTON Haw 


FIG.  46.    ROOF  WARD— MATERNITY  BUILDING,   BRIDGEPORT    (CONN.)    HOSPITAL. 
Edward  F.  Stevens,  Architect. 


38 


THE  AMERICAN  HOSPITAL 


3  s 

p  „ 

M     . 
f-i  -a 

S  I 

<; 


OF  THE  TWENTIETH  CENTURY 


39 


FIG.  43.    MATERNITY  WARD-ERIDGEPORT   (CONN.)   HOSPITAL. 
Edward   F.   Stevens,  Architect. 


FIG  49. 


PRIVATE  ROOM-MATERNITY  BUILDING,  BRIDGEPORT  (CONN.)  HOSPITAL. 
Edward  F.   Stevens,   Architect. 


40 


THE  AMERICAX  HOSPITAL 


d  a"D  n  c|  ponnn 
no  liif 


O 

o 

t_ 

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Li 


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OF  THE  TWENTIETH  CENTURY 


4i 


complete  and  thoroughly  equipped  pri- 
vate-patient pavilion  for  this  institution. 
The  general  plan  (Fig.  64)  shows  the 
location  in  connection  with  the  existing 
hospital.  It  has  been  necessary  to  plan 
with  precipitous  grades,  and  the  ap- 
proach to  this  pavilion  from  the  main 
hospital  is  over  a  bridge  from  the  second 
story  of  the  original  building ;  thence 
through  the  tunnel  into  the  mountain; 
thence,  by  means  of  elevators  and  stair- 


cases, to  the  various  floors  of  the  new 
pavilion. 

While  every  institution  should  have  its 
entrance  speak  "Welcome"  to  the  coming 
guest,  it  is  doubly  important  in  a  build- 
ing of  this  kind  that  much  care  be  de- 
voted to  making  an  entrance  commen- 
surate with  the  object  for  which  the 
building  is  erected.  The  severe  hygienic 
detail  which  it  is  desirable  to  use  where 
surgery  and  surgical  dressings  are  under 


42 


THE  AMERICAN  HOSPITAL 


way  can  be  abandoned  here  and  the 
aesthetic  side  considered.  While  the  ques- 
tion of  hygiene  should  never  be  lost  sight 
of  in  any  hospital  department,  the  hos- 
pital architect  should  not  be  a  slave  to  this 
fancy,  but  should  be  able  to  couple  good 
hygiene  with  good  design. 

The  medical  department  of  this  build- 
ing is  as  complete  as  that  of  any 
of  its  kind  in  America,  for  the 
authorities  of  the  hospital  realized  that 


the  physician  should  have  greater  op- 
portunities for  his  work  than  are  pro- 
vided in  the  majority  of  medical  institu- 
tions. 

The  surgical  department  is  most  com- 
plete. The  system  of  lighting  is  entirely 
indirect,  no  lighting  fixture  being  in  the 
operating  room,  but  all  concealed  behind 
the  glazed  ceiling. 

Entirely  new  models  of  sterilizers  were 
designed     for     this     building.     Distilled 


OF  THE  TWENTIETH  CENTURY 


43 


Edwab-d    F   .Stevens 
ARCHITECT      Boston  «ass. 


'■■■'■■»■>  GE.OUND    Floor.  Plan 

FIG.   53.    OHIO  VALLEY  GENERAL  HOSPITAL.    GROT-XT;    VJ/^nR  PLAX. 


FIG.  54.    AIRING  BALCONY,  FIRST,  SECOXD  AXD  THIRD  FLOORS,  OHIO  VALLEY  GENERAL 

HOSPITAL  WHEELING,  W.  VA. 
Edward   F.    Stevens,.   Architect. 


44 


THE  AMERICAN  HOSPITAL 


OTIrlifHijii  iiiiji 


£  II1IIII1I 


iH 


FIG.  54A.    OHIO  VALLEY  GENERAL  HOSPITAL.    M:EW  FROM  REAR,  SHOWING  AIRING 

BALCONIES. 


FIG.    56.    MACON   HOSPITAL.    PRR'ATE    PAVILION.    ROOF    PLAN. 


OF  THE  TWENTIETH  CENTURY 


45 


T         Z  t  E  T 


MACON  CITY  tiO/PITAL 
MACON  QtouqiA 

CCWftU)  f   /Ttvtn/  AlCnlTECT 

AlUAWHK  ilAJl  ^//OCJATEO  AtCHITCCT 


FIG.    55.     FIRST    FLOOR    PLAN. 


46 


THE  AMERICAN  HOSPITAL 


FIG.   SSA.    MACON   HOSPITAL.     PRIVATE   PAVILION. 


-Pavilion  "P" 

FIG.  SSB.    MACON  HOSPITAL.    PRIVATE  PAVILION. 


OF  THE  TWENTIETH  CENTURY 


47 


FIG.   59.    HAMOT   HOSPITAL,   ERIE,   PENN. 


FIG.  60. 


48 


THE  AMERICAN  HOSPITAL 


MANsriLLp  Ge:nl!?al  Hospital 
MANsntLD    Ohio 

VtCfioli  £tDDI'i(^-AECHrrtCT-  MA^iMCLD-OHlO 
CDWAEOt-rTtVENJ-CortJOLTIIiq    AtCtllTtCT- BDJTa>l-M«« 


FIG.   57. 


water  for  drinking  purposes  is  provided 
on  all  floors. 

A  series  of  balconies  from  private 
rooms  is  arranged  on  all  sides  of  the 
building,  making  it  possible  for  the 
patients     to     have    their     own     private 


balconies,  just  as  they  have  their  own 
baths  and  toilets.  Additional  airing  bal- 
conies for  every  floor  are  provided. 

Much  of  the  equipment  for  Rontgen 
ray  department  was  especially  designed 
for  this  building. 


OF  THE  TWENTIETH  CENTURY 


49 


FIG.    58.    MANSFIELD    GENERAL    HOSPITAL,    MANSFIELD,    O.    SECOND    FLOOR    PLAN. 


FIG.  61.    SAN   FRANCISCO  HOSPITAL.    TYPICAL  WARD  UNIT. 

1   Solarium.    2.   Laboratory.    3.   Dining  Room.    4.   Diet   Kitchen.    5   Dressing   Room.    6.   Toilet.    7.    Ward. 
8.  Two-Bed  Ward.    9.  Toilet.    10.  Two-Bed   Ward. 


50 


THE  AMERICAN  HOSPITAL 


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OF  THE  TWENTIETH   CENTURY 


51 


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52 


THE  AMERICAN  HOSPITAL 


FIG.  64.    GENERAL  PLAN. 


OF  THE  TWENTIETH  CENTURY 


53 


FIG.  65.  GROUND  FLOOR  PLAN  AND  PLAN  OF  TYPICAL  FLOOR— ROSS  PAVILION,  ROYAL 

VICTORIA  HOSPITAL,  MONTREAL,  CANADA. 

Stevens    &   Lee    and   Kenneth   G.    Rea,    Architects. 


FIG.   66.    TYPICAL    FLOOR— ROYAL   VICTORIA   HOSPITAL,    ROSS    PAVILION. 


54 


THE  AMERICAN  HOSPITAL 


FIG.  67.    ROYAL  VICTORIA  HOSPITAL.    ROSS  PAVILION. 


FIG.   67B. 


WEST   SIDE   OF   ROYAL   VICTORIA   HOSPITAL,   MONTREAL,   CANADA. 
Stevens    &   Lee    and   Kenneth    G.    Rea,   Architects. 


OF  THE  TWENTIETH  CENTURY 


55 


56 


THE  AMERICAX  HOSPITAL 


FIG.   6;D.    ROSS    PA\r[LIOX,    ROYAL    VICTORIA.      EXTRAXCE    LOBBY. 


OF  THE  TWENTIETH  CENTURY 


57 


Tt«cal  ■ Ploob  Plan 


FIG. 


PRIVATE  PAVILION  FOK  THE  BUFFALO  GENERAL  HOSPITAL,  BUFFALO,  NEW  YORK. 

Edward    F.    Stevens,   Architect. 


CHAPTER  IV. 


l^lje  Surgical  or  (©perating  Winit 


In  American  hospitals,  the  surgical  or 
operating  unit  takes  a  greater  variety  of 
forms  than  does  the  ward  unit.  It  is 
probable  that  no  one  can  say  with  author- 
ity that  this  or  that  is  the  ideal  arrange- 
ment for  this  important  part  of  the  hos- 
pital. We  cannot  take  as  our  model  any  of 
the  European  operating  building  plans, 
since  conditions  there  are  vastly  different. 
In  the  German  government  hospitals,  one 
surgeon  will  do  the  majority  of  the  op- 
erations and  naturally  will  need  but  one 
or  two  rooms.  In  our  own  hospitals, 
with  the  large  staffs  in  even  those  of  only 
one  hundred  beds,  it  is  not  uncommon  to 
find  five  or  six  operations  going  on  at 
once. 

In  illustration  of  this  point  there  may 
be  given  a  few  notable  examples.  The 
Virchow  at  Berlin  (Fig.  1),  with  its  two 
thousand  patients,  a  large  percentage  of 
whom  are  surgical,  has  but  four  operat- 
ng  rooms,  one  of  them  for  known  septic 
cases.  In  the  Munich-Schwabing,  with 
one  thousand  beds,  there  is  but  one  for 
clean  operations.  In  this  country,  on  the 
other  hand,  we  find  in  many  compara- 
t'ively  small  hospitals  a  very  large  propor- 
tion of  operating  rooms.  In  the  Massa- 
chusetts General  Hospital  (Fig.  70), 
with  two  hundred  and  fifty  beds,  there 
are  five  operating  rooms,  besides  those 


in  the  accident  and  orthopedic  depart- 
ments. The  Grace  Hospital  at  Detroit 
(Fig.  71),  with  two  hundred  patients, 
has  four  operating  rooms,  besides  surgi- 
cal dressing  rooms.  In  the  Youngstown 
Hospital,  with  one  hundred  and  fifty 
beds,  four  operating  and  two  accident 
rooms  are  provided.  The  Peter  Bent 
Brigham  Hospital,  with  two  hundred  and 
twenty-five  beds,  has  three  operating 
rooms.  The  Bridgeport  hospital,  with 
two  hundred  beds,  has  three  operating 
rooms. 

Our  construction  is  governed  largely 
by  the  methods  of  the  local  surgeons  who 
are  to  work  in  any  given  building.  Every 
year  there  come  new  methods  in  operat- 
ing, affecting  everything  from  the  an- 
esthesia of  the  patient  to  his  recovery. 
A  building  planned  to  meet  the  require- 
ments of  today  may  therefore,  when  fin- 
ished eighteen  months  hence,  be  found 
lacking  in  some  essential  detail.  Thus  it 
is  that  the  up-to-the-minute  operating 
unit  is  well-nigh  impossible  to  obtain. 

The  operating  department  should, 
where  possible,  be  isolated.  A  separate 
building  is  the  ideal  arrangement.  Where 
this  is  not  possible,  the  upper  story  (if 
there  is  elevator  service)  should  be  used 
and  the  department  well  separated  from 
other  rooms. 


58 


THE  AMERICAN  HOSPITAL 


^oeeioot^  TO 


v^-^jtr>» 


FIG.    70.    MASSACHUSETTS    GENERAL    HOSPITAL.    OPERATING    DEPARTMENT. 


If  the  operating  department  is  in  a 
separate  building,  there  should  be  an  ad- 
mitting room  at  the  ambulance  entrance, 
closely  connected  with  the  accident  room 
which  should  have  good  north  light. 
These  rooms  should  not  connect  with 
anything  except  the  corridor.  This  ac- 
cident room  can  also  be  used  for  septic 
cases. 

The  day  of  the  amphitheatre  in  the 
modern  hospital,  as  an  operating  unit  for 
teaching,  seems  to  have  gone.  While  the 
amphitheatre  is  used,  of  course,  for  teach- 
ing in  clinics  and  lectures,  the  majority 
of  surgeons  have  come  to  the  conclusion 
that  in  order  to  gain  an  intimate  knowl- 
edge of  live  tissue  the  student  must  be 
very  close  to  the  patient  under  operation, 
and  smaller  and  more  numerous  classes 
are  formed. 

The  major  operating  room  should  have 
no  plumbing  or  other  attached  fixtures, 
except  perhaps  a  flushing  floor  drain  and 
a  sterile  water  outlet.  A  small  electric 
instrument  sterilizer  may  be  thought  de- 
sirable, but  with  the  sterilizing  room 
close  at  hand  this  is  not  necessary. 


The  heating  of  the  operating  room 
should  be  sufficient  for  any  desired  tem- 
perature within  reason.  Fresh  air 
should  be  introduced  to  make  the  room 
comfortable  to  work  in.  This  can  be  ac- 
complished in  various  ways — by  the 
plenum  system,  where  the  air  is  heated 
and  blown  in  by  fans ;  by  gravity,  with 
screens  to  prevent  air  from  being  fouled 
by  dust;  and  by  direct-indirect,  with 
proper  air  inlets  carefully  screened. 
There  can  be  no  objection  to  direct  heat, 
provided  the  heating  units  are  readily  ac- 
cessible for  cleaning,  and  provided  fresh 
air  can  in  some  way  be  introduced.  But 
the  rooms  used  for  operating,  sterilizing, 
and  anesthetizing  must  be  well  ventilated 
always.  (See  Chapter  XV,  "Heating  and 
Ventilation.") 

The  lighting  of  the  operating  room 
needs  careful  study,  both  for  day  and 
for  night.  For  the  day,  large  vertical 
windows  and  skylight,  facing  toward 
the  north  or  as  near  north  as  possible, 
are  best.  By  carrying  the  vertical 
window  sufficiently  high,  practically  the 
same   results   without   skylights   are   ob- 


OF  THE  TWENTIETH   CENTURY 


59 


FIG.  71.    GRACE  HOSPITAL,  DETROIT.    OPERATING  DEPARTMENT. 

Edward    F.    Stevens,    Architect. 


I  •  p  L..A  N  •  OF-    T-tjiR.©.    p'uoo  Re- 


tained so  far  as  light  is  concerned — e.  g., 
Macon,  Cable  Memorial  and  Williams 
Hospitals.  The  glazing,  in  cold  climates, 
should  be  double,  or  with  a  glass  screen 
as  at  the  Jefferson  in  Philadelphia,  the 
Bridgeport  at  Bridgeport,  the  Royal  Vic- 
toria at  Montreal,  etc.  The  skylight 
windows  may  have  rolling  shades  be- 
tween the  two  panes  of  glass  in  case  the 
light  is  too  strong. 

There  is  much  to  be  said  in  regard  to 
artificial  lighting.  The  crane  light  has 
been  used  successfully,  having  the  ad- 
vantage of  a  direct  and  powerful  light 
when  needed  and  of  being  swung  away 


easily  when  not  wanted.  (See  Artificial 
Lighting  under  Chapter  XIV.  j 

Reflected  light  from  a  high  power  lan- 
tern outside  the  operating  room,  with 
fixed  reflecting  mirrors,  has  been  used 
with  much  success.  Trouble,  however, 
has  been  experienced  through  the  vibra- 
tion of  the  building,  which  changed  the 
adjustment. 

Reflected  lights  from  numerous  fix- 
tures, either  with  direct  reflectors  or  dif- 
fused from  the  ceiling,  have  been  very 
successful. 

Daylight  effect  is  very  desirable  in  the 
operating    room.      There    are    different 


60 


THE  AMERICAN  HOSPITAL 


lamps  and  combinations  with  occasional 
improvements.  The  best  of  today  ap- 
pears to  be  from  high  power  nitrogen 
lamps  above  the  ceiling  diffused  by  inter- 
vening glass  of  proper  quality. 

One  can  hardly  name  the  best  floor  for 
an  operating  room.  There  are  many  good 
materials,  such  as  non-absorbent  marble, 


FIG.  72.    ST.  GEORG  HOSPITAL. 
OPERATING  UNIT. 

vitreous  tile,  terrazzo.  and  even  cement 
if  treated  with  a  non-dusting  prepara- 
tion. 

The  zvalls  of  the  operating  room  should 
either  be  lined  with  marble  or  tile,  or 
finished  in  hard  plaster  and  thoroughly 
enamelled.  It  must  be  possible  to  scrub 
thoroughly  or  spray  with  water  or  steam 
the  entire  surface  of  the  walls  and  floor. 
To  this  end,  a  floor  drain  of  proper  con- 
struction should  be  supplied.  (See 
Chapter  XV,  "Plumbing.") 

It  has  been  found  that  a  clear  white 
tile  on  floor  and  w^alls  is  too  glaring  in 
the  intense  light  of  the  operating  rooms ; 
and  gra}^  buff,  and  even  green  have  been 
used  with  success.  Gray  Tennessee  mar- 
ble is  very  satisfactory. 

Next  in  importance  to  the  operating 
room  is  the  sterilizing  room.  This  need 
not  be  large,  but  should  be  specially  ven- 
tilated ;  all  exhaust  steam  pipes  should 
be  extended  into  the  open  air ;  and  if  a 
hood  can  be  placed  over  the  sterilizer,  it 
should  be  done.  It  is  advisable  to  place 
the  water  sterilizers  or  still  at  an  eleva- 
tion, so  that  the  sterile  water  may  flow  to 
each  operating  room  and,  by  the  use  of 
reheaters,  be  heated  by  steam  or  elec- 
tricity. Such  reheaters  should  be  pro- 
vided with  elbow  control  valve  and  the 


discharge  nozzle  protected  from  contact 
by  a  metal  or  glass  hood.  A  proper  re- 
ceptacle, like  a  porcelain  sink,  properly 
trapped,  should  be  placed  under  the  re- 
heater. 

The  nurses'  zvorkroom  should  be  large 
enough  for  the  corps  of  nurses  needed, 
should  be  provided  with  tables  for  mak- 
ing up  dressings,  with  sinks,  slabs  for 
cleaning  instruments,  special  scrub-up 
bowls  for  the  clean  nurses,  cabinets  for 
sterile  and  unsterile  dressings,  etc. 

The  small  laboratory  for  quick  diag- 
noses is  considered  a  necessary  part  of 
the  operating  suite.  It  should  be  well 
provided  with  apparatus  for  making 
rapid  microscopic  examinations  of  tissue 
while  the  patient  is  still  on  the  table. 

There  should  be  a  surgeons'  room  or 
rooms,  of  sufficient  size,  supplied  with  a 
locker  for  each  surgeon,  comfortable  fur- 
niture, shower  bath  and  toilet.  The  in- 
strument room  may  have  a  locker  or  com- 
partment for  each  surgeon's  instruments. 
Anaesthetizing  rooms,  well  ventilated, 
should  be  sufficiently  screened  from  the 
operating  corridor,  yet  near  the  operating 
rooms,  and  should  have  doors  of  ample 
width  to  admit  a  bed,  with  jambs  and 
doors  protected  by  metal. 


FIG.  73.    ST.  GEORG  HOSPITAL. 
OPERATING  UNIT  SECTION. 

The  scrub-up  sinks  should  be  either  in 
the  corridor  or  in  an  open  alcove  without 
doors  near  the  operating  room  where 
there  will  be  plenty  of  room  for  all  to 
work  without  interference,  and  w'ith 
plent}'  of  shelf  room  for  soap,  brushes,  etc. 

The  details  of  finish  and  equipment, 
the  plumbing  and  heating  of  the  operat- 


OF  THE  TWENTIETH   CENTURY 


61 


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62 


THE  AMERICAN  HOSPITAL 


ing  suite  ^vili  be  taken  up  in  later  chap- 
ters. 

The  operating  department  of  the  St. 
Georg  Hospital  (Fig.  72)  at  Hamburg 
is  one  of  the  most  carefully  worked  out, 
so  far  as  hygienic  detail  is  concerned. 
Strict  attention  is  given  to  the  heating 
and  ventilation  (Fig.  7Z)  ;  the  air  is 
washed  and  filtered  before  entering  the 
room,  and  the  direct  heating  units  are  en- 
tirely outside  the  v/alls.  The  equipment 
is  most  carefully  designed. 


The  accident  department,  on  the 
ground  floor,  gives  access  for  ambulance 
patients ;  the  elevator  reaching  the  first 
floor  level.  On  the  ground  floor  are 
the  receiving  and  waiting  rooms,  the 
two  accident  rooms,  laboratories,  morgue 
and   store  rooms. 

On  the  first  floor  are  the  operating 
rooms,  with  two  anesthetizing  rooms, 
which  are  placed  in  the  center  of  the 
building,  with  skylights,  and  are  entered 
either  from  the  main  corridor  or  from 


o        ■ —     -     « Ifc 


QUINCY    CITY    HOSPITAL.    OPERATING    BUILDING. 

Edward    F.    Stevens,    Architect. 


R.ICE.PAVIHOM 


In  the  operating  department  of  Grace 
Hospital,  Detroit  (Fig.  71),  there  are 
three  rooms  for  clean  surgery,  besides 
the  septic,  surgical  dressing,  and  plaster 
rooms.  The  surgeons'  locker  and  dress- 
ing rooms  are  outside  the  clean  portion 
of  the  department.  Here  the  room  for 
scrubbing  up  is  not  connected  with  the 
locker  room.  There  is  a  large  sterilizing 
room  and  a  larger  room  for  the  nurses' 
work  of  preparation ;  also  an  instrument 
room  where  each  surgeon  has  his  own 
compartment  in  the  instrument  case,  etc. 

The  operating  building  of  the  Youngs- 
town  Hospital  (Fig.  74),  Youngstown, 
O.,  is  two  stories  in  height,  and  is  divided 
into  two  sections — the  accident  and  the 
operating  proper. 


the  operating  corridor.  This  makes  it 
unnecessary  for  the  patient  to  enter  the 
operating  corridor  until  anesthetized. 
The  three  clean  operating  rooms  open 
from  a  ten-foot  corridor,  in  which  are 
the  surgeons'  scrub-up  bowls,  so  placed 
that  six  men  may  scrub  at  once.  A  sep- 
tic operating  room  is  provided,  a  large 
sterilizing  room,  a  large  work  room  for 
nurses,  instrument  room  and  a  small 
laboratory. 

Sterile  water  is  brought  from  a  cen- 
tral apparatus  to  each  operating  and  ac- 
cident room,  and  there  heated  locally  by 
electricity. 

The  Qiiincy  City  Hospital  (Figs.  75 
and  76),  Quincy,  Mass.,  is  a  small  in- 
stitution with  a  capacity  for  fifty  beds. 


OF  THE  TWENTIETH   CENTURY 


63 


NO.  1(>.    QUINCY  CITY  HOSPITAL.    VIEW  IN  OPERATING  ROOM,  SHOWING  GLASS  SLIDE  OVER 

INSTRUMENT    STERILIZER. 


foucTH  Floor.  Plan 


AE.CH1TECT'        BoiTON  MaJS- 


FIG.  n.    PLAN  OF  FOURTH  FLOOR,   OHIO  VALLEY  GENERAL  HOSPITAL,   WHEELING.   W.  VA 

Edward   F.    Stevens,   Architect. 


64 


THE  AMERICAN  HOSPITAL 


FIG.  78.    OPERATING  ROOM— OHIO  VALLEY  GENERAL  HOSPITAL,  WHEELING,  W.  VA. 

Edward    F.    Stevens,    Architect. 


FIG.   19.    RHODE   ISLAND   HOSPITAL.    OPERATING    SECTION. 


OF  THE  TWENTIETH  CENTURY 


65 


but  its  operating  department  is  in  a  sepa- 
rate building.  In  this,  all  the  essentials 
have  been  provided.  The  accident  and 
Roentgen-ray  rooms  and  surgeons'  room 
are  removed  from  the  clean  corridor. 

At  the  Ohio  Valley  General  Hospital 
(Fig.  77),  one  wing  of  the  fifth  floor  is 
set  apart  for  the  operating  department, 
with  one  septic  and  two  clean  operating 
rooms.  The  scrub-up  basins  are  placed 
in  the  center  of  an  open  cross  corridor, 
accessible  from  all  sides.  Sterilizing 
room,  nurses'  work  room,  surgeons'  and 
anesthetizing  rooms  are  placed  conven- 
iently for  service.  Distilled  water  from 
a  supply  tank  in  the  tower  furnishes 
sterile  water  for  the  operating,  accident, 
maternity,    and   laboratory   departments. 

The  operating  pavilion  of  the  Cincin- 
nati General  Hospital  (Figs.  86  and  87) 
is  most  complete,  each  operating  unit 
having  its  own  anaesthetic  room  adjoin- 
ing and  recovery  room  close  at  hand. 
The  necessary  nurses'  work  rooms, 
dressing,  instrument,  and  laboratory 
rooms  are  provided. 


The  lecture  amphitheatre,  while  in  the 
same  building,  is  not  directly  connected, 
but  is  reached  through  the  lower  level 
and  approached  by  two  elevators  and 
staircases. 

It  is  quite  common,  in  modernizing  an 
old  hospital,  for  the  provision  for  the 
operating  department  to  be  somewhat 
limited;  and  it  is  not  an  unusual  thing 
for  the  attic  story,  which  has  been  used 
as  kitchen  or  servants'  quarters,  to  be 
turned  over  to  the  architect  to  make  into 
a  modern  operating  department.  Two  or 
three  examples  of  this  may  be  helpful. 

In  the  Rhode  Island  General  Hospital 
fFig.  79)  at  Providence,  an  unused  up- 
per story  was  utilized,  providing  five 
good  operating  rooms,  and  all  the  con- 
veniences of  a  modern  surgical  unit. 

In  the  New  York  City  Hospital 
(Fig.  80),  Blackwell's  Island,  the  dome 
of  the  old  building,  formerly  used  as  a 
kitchen,  was  so  reconstructed  as  to  meet 
the  needs  of  the  surgeons.  The  struc- 
ture of  the  roof  trusses  made  the  plan- 
ning more  difficult,  and  the  spaces  which 


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Cuo/ET    BPee/zing  Room 


FIG.  80.    NEW  YORK  CITY  HOSPITAL,  BLACKWELL'S  ISLAND. 
Charles   B.   Meyers,    New    York,    and   Edward   F.    Stevens,    Boston,   Architects. 


^ 


THE  AAIERICAN  HOSPITAL 


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FIG.  81.    BRIDGEPORT  HOSPITAL.    OPERATING  DEPARTMENT. 
Edward   F.    Stevens,   Architect. 


would  in  an  ordinary  case  be  used  as  op- 
erating rooms  were  very  conveniently 
turned  into  nurses'  and  students'  locker 
rooms,  and  entrance  to  students'  gallery 
(in  no  sense  an  amphitheatre).  Sky- 
lighting of  all  rooms  was  practically 
necessary.  Four  operating  rooms  are 
provided,  only  two  of  which  could  have 
the  north  exposure.  Here  again  dis- 
tilled water  is  made  at  an  elevation,  and 
conducted  to  the  various  rooms. 

At  the  Bridgeport  Hospital  (Figs.  81 


and  82)  the  case  was  slightly  different. 
An  old  operating  theatre,  with  a  small 
addition,  was  turned  into  three  modern 
operating  rooms,  with  sterilizing,  instru- 
ment and  work  rooms.  Entrance  for 
students  to  the  major  operating  room 
was  secured  by  a  gallery  from  the  main 
corridor. 

Built-in  cabinets  (Fig.  83),  distilled 
water  reheaters,  and  specially  designed 
equipment  make  this  a  very  complete 
department. 


OF  THE  TWENTIETH   CENTURY 


67 


CHAPTER  V. 

®|)e  JHebical  ®nit 


The  fact  is  recognized  more  and  more 
every  year  that  many  diseases  and  ail- 
ments which  have  hitherto  been  consid- 
ered surgical  cases  or  which  have  been 
neglected  altogether  can  be  treated  with- 
out surgery  and  with  little  medicine.  The 
medical  treatment  or  bath  department, 
as  it  is  called  in  European  countries,  is 
gradually  being  introduced  into  the  gen- 
eral hospital  plan.     Today  a  careful  stu- 


The  hospital  boards  in  this  country 
have  given  little  thought  to  this  depart- 
ment, but  in  the  larger  European  hospi- 
tals one  will  find  the  medical  units  with 
such  sections  as 

Mechano-therapy. 
Hot  air  baths. 
Warm  air  baths. 
Steam  baths. 
Light    baths. 


FIG.  83.    BRIDGEPORT  HOSPITAL.    OPERATING  SECTION  SHOWING  BUILT-IX  CASES. 


dent  of  hospital  architecture  will  not  dare 
to  plan  for  a  complete  layout  without 
providing  facilities  for  some  medical 
treatment,  if  it  is  nothing  more  than  a 
few  electric-light  bakers.  We  should  not 
give  to  the  surgeon  and  the  obstetrician 
all  the  best  rooms  of  our  hospitals,  but 
should  provide  space  for  the  present  and 
for  the  future  for  internal  medicine  and 
therapeutics. 


Electric  baths. 

Gas   baths. 

Radium   baths. 

Sand  baths. 

Sulphur  baths. 

Mud  or  peat  baths. 

Sun   baths. 

Inhaling    and    pneumatic    chambers. 

Roentgen-ray,   with   all   its   ramifications. 

To  the  student  of  hospital  architecture 
the    question   naturally   arises :    If   these 


68 


THE  AMERICAX  HOSPITAL 


FIG.   82.    MAJOR   OPERATIXG   ROOM— BRIDGEPORT    (COXX.J    HOSPITAL. 
Edward   F.   Stevens,   Architect. 


methods  of  treatment  are  essential  for 
the  well-being  of  the  poor  and  indigent 
across  the  sea,  why  should  we  not  prac- 
tice them,  or  some  of  them  at  least,  in 
our  institutions? 

The  hydro-electric  bath,  the  carbon  di- 
oxide bath,  the  plunge,  and  those  previ- 
ously mentioned,  are  but  a  few  of  the  ex- 
amples one  will  find  in  the  general  pub- 
lic hospitals  of  Europe.  Reference  is 
not  made  to  the  various  sanatoriums  one 
finds  over  all  the  world,  but  to  the  gen- 
eral hospitals  for  the  care  of  the  poor 
and  indigent.  Should  we  not,  in  Amer- 
ica, provide  such  equipment  that  the  pa- 
tient suffering  from  arthritis,  chronic 
rheumatism,  or  cellulitis,  let  us  say,  may 
have  the  proper  mechanical,  electrical. 
heat  and  massage  treatment,  or  the  wa- 
ter-bed for  severe  bodily  burns  or  sores  ? 

It  is  not  necessary  to  have  a  five-thou- 
sand dollar,  complete  hydro-therapeutic 
outfit;  but  room  can  be  secured  in  every 
hospital  for  a  small  equipment — an  elec- 
tric baker,  massage  table,  small  vapor 
bath,  etc. — and  many  simple  home-made 


devices  can  be  brought  into  use,  if  the 
medical  student  of  today  will  only  pre- 
pare himself  to  use  them  w^hen  he  comes 
to  be  on  the  hospital  staff  of  the  future. 

Heat  is  an  important  therapeutic 
agent,  whether  it  is  applied  by  warm  air, 
steam,  electric  light,  or  natural  sunlight; 
scientifically  applied,  it  is  a  recognized 
medium  for  benefiting  man's  ills. 

If  heat  applied  by  the  direct  rays  of  an 
arc  light  has  a  higher  therapeutic  value 
than  when  applied  by  any  other  method, 
then  this  should  be  recognized  and  the 
equipment  supplied.  If  the  hot  air  bath 
will  relieve  pain  when  nothing  else  will, 
then  this  should  be  recognized.  As  the 
study  of  non-surgical  methods  for  re- 
lieving suffering  advances,  hospitals 
should  be  prepared  to  provide  the  proper 
treatment. 

The  airing  balcony  provides  sunlight 
for  the  medical  as  well  as  for  the  sur- 
gical patient.  The  simplest,  and  many 
times  the  most  potent  agency,  Sunlight, 
can  easily  be  provided  in  every  institu- 
tion. 


OF  THE  TWENTIETH   CEXTURY 


69 


FIG.    84.    FIRST   AND    SECOND    FLOORS-ADMIXISTRATIOX   BUILDING,    ST.    LUKE'S    HOSPITAL. 
Edward   F.    Stevens,   Architect;   Mellen   C.    Greeley,   Associate  Architect. 


FIG.  85.  ST.  LUKE'S  HOSPITAL,  JACKSONVILLE.  ADMINISTRATION  AND  OPERATING  BUILDING. 


70 


THE  AMERICAN  HOSPITAL 


OF  THE  TWENTIETH   CENTURY 


71 


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THE  AMERICAN  HOSPITAL 


FIG.  88.    J5R.   WILLIAMS'   PRIVATE   SANATORIUM.    VIEW   IN   OPERATING   ROOM. 


To  illustrate  what  some  of  the  later 
European  hospitals  are  doing  in  the  line 
of  medical  equipment,  a  few  examples 
are  here  shown. 

The  Virchow,  at  Berlin  (Fig.  1)  de- 
votes even  more  room  to  the  medical 
treatment  department  than  to  the  sur- 
gical. 

At  the  Barmbeck  (Fig.  2),  Ruppel's 
latest  hospital,  at  Hamburg,  the  bath- 
house is  given  the  place  of  honor  on  the 
main  axis,  while  the  operating  pavilion 
occupies   a  secondary  position. 

The  Bispebjerg  (Fig.  3)  at  Copen- 
hagen, among  the  newest  large  Scandi- 
navian hospitals,  has  devoted  a  large 
space  to  this  department,  which  is  en- 
tered by  semi-underground  passages. 

In  Munich-Schwabing  (Fig.  4),  one 
of  Europe's  best  hospitals,  one  finds  a 
most  complete  equipment.  If  we  study 
this  plan  in  detail.  (Fig.  100)  we  find 
baths  of  every  kind  for  the  relief  of  suf- 
fering humanity.  Commencing  at  the 
left  are  the  Roentgen-ray  department, 
the     inhalation     department,     the     rest 


rooms,  pneumatic  chamber,  massage  and 
mechano-tlierapy ;  and  in  the  center  are 
arranged  the  various  baths— the  Fango 
or  Italian  volcanic  earth  bath,  the  mud 
or  peat  bath,  sand  baths  where  the  sand 
is  heated  and  applied  to  the  patient,  the 
CO-  bath,  the  light  bath,  and  the  general 
hydro-therapeutic  room  with  its  spray 
baths  of  every  description,  its  warm  and 
cold  plunge,  and  its  wading  bath. 

On  the  second  story  of  this  building 
is  the  great  sun-bath,  so  arranged  that 
if  the  sun  is  too  warm  the  surface  of  the 
glass  can  be  covered  by  a  water  curtain, 
thus  reducing  the  temperature  of  the 
room. 

In  this  hospital  the  writer  first  saw 
the  pneumatic  chamber  used  for  treat- 
ment (Fig.  101).  A  patient  needing  rari- 
fied  air  and  sent  to  the  hospital  is  placed 
in  one  of  these  rooms,  surrounded  by  his 
books  and  papers ;  pressure  in  the  room 
is  reduced  to  the  prescription  amount  and 
he  is  getting  the  rarified  air  of  the  high 
mountains  at  home.  Perhaps  he  may  be 
ordered  a  greater  atmospheric  pressure, 


OF  THE  TWENTIETH   CENTURY 


IZ 


FIG.  89.    BARRE  CITY  HOSPITAL,  BARRE,  VT.    VIEW  IN  MAJOR  OPERATING  ROOM. 

Edward   F.   Stevens,   Architect. 


74 


THE  AMERICAN  HOSPITAL 


o  - 

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2  ^ 


OF  THE  TWENTIETH   CENTURY 


75 


fousTH    fLcce  Plan 


Pkivatc   Pavilion    fojt 
TUt  BurfALO  GtNEEAL  HOJPITAL 
BurfALO  NtW  YOKK 


FIG.   92.    NEW   OPERATING   DEPARTMENT. 


in  which  case  the  chamber  is  put  under 
pressure  instead  of  suction. 

The  water  bed  (Fig.  102)  is  used  for 
the  rehef  of  many  troubles  and  is  con- 
sidered one  of  the  indispensable  pieces 
of  equipment.  At  the  St.  George  the 
writer  saw  one  poor  fellow  in  the  water 
bed,  which  he  had  occupied  for  months, 
eating,  sleeping  and  reading,  who  could 
not  have  lived  under  other  conditions. 
One  will  see  this  water-bed,  or  full- 
length  tub  with  adjustable  hammock,  in 
many  wards  in  Europe.  In  one  hospital 
that  the  writer  visited  each  medical 
ward  had  its  water-bed,  and  in  other 
wards  each  bed  was  provided  wdth  pipes 
from  the  w^all,  for  cold  water  circulation 
in  place  of  ice  caps. 

The  sand  bath  (Fig.  103),  where  the 
patient  is  packed  in  sterile  sand  at  the 
proper  temperature,  is  found  in  almost 
every  large  European  hospital. 

There  are  few  hospitals  in  the  world, 
however,  which  have  a  more  complete 
mechano-therapy  equipment  than  the 
Massachusetts  General  Hospital,  Bos- 
ton, with  its  splendid  Zander  room  (Fig. 
104).  But  even  here  the  service  is 
largely  that  of  the  surgical  side. 

Today  nearly  every  hospital,  large  or 
small,  has  its  Roentgen  or  X-ray  outfit. 
(See  Chapter  XL)  In  many  a  more  or 
less  complete  hydro-therapeutic  depart- 
ment is  provided. 

In  discussion  with  various  medical 
specialists,  they  have  acknowledged  the 
value  of  equipment  and  recommend  it 
where  possible,  especially  the  full-length 
continuous  bath  or  water-bed,  the  hydro- 
therapy and  baking.    In  designing  a  new 


hospital  there  should  be  set  apart  certain 
rooms  to  be  reserved  for  medical  treat- 
ment rooms,  for  within  a  very  short  time 
the  medical  men  will  demand  more  equip- 
ment. 

In  the  St.  Luke's  Hospital  (Fig.  84) 
at  Jacksonville  about  one-half  of  the  sec- 
ond story  of  the  administration  building 
is  set  apart  for  medical  treatment.  This 
portion  is  not  equipped,  but  is  ready 
whenever  the  demand  comes  and  the 
funds  necessary  to  equip  and  maintain  it 
are  obtained. 

In  the  Ohio  Valley  General  Hospital 
the  same  is  true  (Fig.  16). 

In  the  Ross  Private  Pavilion  of  the 
Royal  Victoria  Hospital  (Fig.  65)  a 
large  section  is  set  apart  and  equipped 
for  medical  treatment,  consisting  of  a 
small  psychopathic  department,  Roent- 
gen-ray department,  hydro-therapy,  elec- 
tric Xauheim,  and  continuous  baths,  res!, 
and  massage  rooms. 

The  Southern  Pacific  and  the  San 
Francisco  County  (Fig.  106)  Hospitals, 
both  at  San  Francisco,  not  only  have  very 
complete  medical  equipment  but  are  us- 
ing it  constantly  with  the  best  results. 

The  help  given  by  scientific  treatment 
to  the  so-called  chronic  invalids  in  some 
of  the  medical  departments  of  the  newer 
hospitals  is  referred  to  as  little  short  of 
miraculous. 

Preventive  medicine  and  treatment  are 
much  discussed.  Why  should  not  the 
medical  treatment  or  bath-house  depart- 
ment, with  its  many  treatment  and  rest 
rooms,  soon  be  as  important  a  factor  in 
our  hospitals  as  our  operating  depart- 
ment is  today  ? 


76 


THE  AMERICAN  HOSPITAL 


1. 

Roentgen  therapeutics. 

13. 

Wash  room. 

2. 

Physicians'  room. 

16. 

Toilet. 

3. 

Dark  room. 

17. 

Rest  room. 

4. 

Light  shaft. 

18. 

Pneumatic  room. 

5. 

Photograph  laboratory. 

19. 

Examination  room 

6. 

Roentgen  room. 

20. 

Physicians'  room. 

'/. 

Undressing  room. 

21. 

Ante-room. 

8. 

Waiting  room. 

12. 

Douche    room. 

9. 

Attendants'   room. 

23. 

Hot  air  bath. 

10. 

Elevator. 

2A. 

Warm  air  bath. 

11. 

Social  room. 

25. 

Vapor  room. 

12. 

Ante-room. 

26. 

Fango  mud  bath. 

13. 

Segregated  room. 

27. 

Mud  bath. 

14. 

Light  bath. 

28. 

Heat  bath. 

29.  Four-cell  bath. 

30.  Electric  water  bath. 

31.  Gas  bath. 

32.  Salt  water  bath. 

33.  Sand  bath. 

34.  Sand  room. 

35.  Sulphur  bath. 

36.  Female  attendants'  room. 

37.  Therapeutic  gymnastics. 

38.  Massage  room. 

39.  Rest    room. 

40.  Hallway. 


FIG.   100.    GROUND  FLOOR  PLAN,  MEDICAL  TREATMENT  BUILDING,  MUNICH-SCHWABING 

HOSPITAL,  MUNICH,  GERMANY. 
Richard    Schachner,   Architect; 


OF  THE  TWENTIETH  CENTURY 


n 


PNEUMATIC  CHAMBER  PLAN. 


FIG.   101.    PNEUMATIC   CHAMBER   SECTION. 


78 


THE  AMERICAN  HOSPITAL 


CHAPTER  VI. 


ZKjje  iHaternitj»  ©epattment 


There  is  a  growing  call  for  maternity 
service  in  nearly  every  hospital,  whether 
it  be  large  or  small.  This  has  made  it 
necessary  to  establish  an  obstetrical  de- 
partment, either  by  setting  apart  a  sec- 
tion of  some  building,  calling  mto 
requisition  an  existing  dwelling  near  the 
institution,  or  erecting  a  new  building  or 
group  of  buildings  for  this  one  service. 

Most  obstetricians  declare  that  the  ma- 
ternity service  should  be  classed  as  surgi- 
cal, since  the  area  of  open  wound  is 
greater  than  in  almost  any  other  clean 
surgery,  and  hence  is  subject  to  greater 
danger  of  infection  from  outside.  Cer- 
tainly modern  asepsis  plays  its  part  in 
this  department,  and  many  a  mother 
owes  her  health  and  perhaps  her  life  to 
the  modern  methods  of  care. 


FIG.     102.     WATER     BED. 

That  such  cases  can  be  more  carefully 
treated  in  the  hospital  than  in  the  home 
no  one  will  gainsay ;  but  to  do  this  to  the 
best  advantage  the  hospital  must  be  espe- 
cially planned  for  the  work.  Study  is 
necessary  toward  minimizing  the  noises 
of  preparing  and  serving  food,  provision 
should   be    made    for    privacy    or    semi- 


privacy   in   the   wards,   and   preparation 
made  for  emergency  conditions. 

There  are  four  distinct  departments  to 
be  considered  in  planning  for  obstetrical 
cases : 

1.  The   waiting   department. 

2.  The   delivery   or   confinement   rooms. 

3.  The     puerperal     or     after-confinement 

rooms. 

4.  The  creche  or  nursery. 

Waiting  Department.  With  private 
patients,  as  a  general  thing,  the  patient 
goes  to  the  hospital  but  a  day  or  two  be- 
fore or  even  on  the  day  of  delivery,  and 
occupies  at  once  the  room  or  bed  that 


FIG.  103.    SAND  BATH. 


will  be  hers  during  her  recovery.  In 
hospitals  where  charity  patients  predom- 
inate the  patients  frequently  enter  from 


OF  THE  TWENTIETH   CENTURY 


79 


fiii         -- ^r^ 

■%r^^ 

Ay_^ 

'     '1     '           1 

'BM    ^ 

J^^                                        h 

ik  Lji-^I  -^       -"St^ 

ry[jk.  JKg 

'"^^^^WS^ 

Sffipsiifj^^ggi^i:; .  ^f 

^..  .-■..-■^-■■""?«ti-'- 

l^^^^i 

HpH^^H^r!^.^  '■' 

1  IjM      ^^^ft^ 

w^ 

'^t'-^^^^^-  -.^'""*-^ 

y.^^A 

watMms^. 

'^^^■^■B^fc^     .^H 

It    jflM 

FIG.  ICM.  MASSACHUSETTS  GENERAL  HOSPITAL.  ZANDER  ROOM. 


FIG.  105.  OHIO  VALLEY  GENERAL  HOSPITAL.  ROENTGEN- RAY  DEPARTMENT. 


80 


THE  AMERICAN  HOSPITAL 


© 


(dI    [^X^\    ^ 


® 


Jg       ®       \@] 


WM 


1,  ^[BlBMTiniT 


San  Franoiaco  Hospital. 
FIG.  106.    MEDICAL  TREATMENT  DEPARTMENT. 


1.  Mechanical  apparatus. 

2.  Plunge  bath. 

3.  Pump  room. 

4.  Toilet. 

5.  Irrigation  room. 

6.  Douche  room. 

7.  Steam    room. 

8.  Toilet. 


9.  Dressing  rooms. 

10.  Lounge  room. 

11.  Hall. 

12.  Store  room. 

13.  Toilet. 

14.  Closet. 

15.  Office. 


one  to  three  months  before  confinement. 
Such  women  assist  about  the  hospital 
work  and  in  a  measure  repay  for  their 
care  when  sick.  Where  such  a  practice 
prevails  separate  wards  or  dormitories 
must  be  provided.  In  charity  homes  for 
unfortunate  girls  the  situation  is  the 
same,  and  in  many  the  waiting  depart- 
ments are  larger  than  the  hospital 
proper.  The  location  of  this  department 
in  the  hospital  group  should  have  most 
careful  study  for  two  reasons  : 

1st — Because,  owing  to  the  crying 
of  the  infants,  it  can  well  be  called 
the  most  noisy  of  all  of  the  depart- 
ments ;  and 

2nd — Because,  owing  to  the  pos- 
sible danger  of  infection  from  out- 
side sources,  it  should  be  as  far  re- 
moved as  possible  from  the  other 
buildings,  and  should  not  be  used  as 
a  passageway  to  any  other  buildings. 

Delivery  Rooms.    The  delivery  rooms, 


with  their  sterilizing  rooms,  labor  rooms, 
doctors'  waiting  room,  etc.,  should  be  cut 
off  from  the  rest  of  the  department  by 
doors.  This  department  should  be 
treated  in  its  details  like  an  operating 
suite. 

The  deliver}'  rooms  should  be  large, 
well  lighted,  and  well  ventilated;  should 
in  fact  be  operating  rooms  with  all  the 
careful  finish  and  detail,  and  should  be 
equipped  both  for  day  and  for  night 
work. 

Either  a  special  sterilizing  room  should 
be  provided,  or  sterilizers  for  water, 
utensils  and  instruments  must  be  placed 
in  the  delivery  room. 

There  should  be  at  least  one  scrub-up 
sink  in  or  near  each  delivery  room.  In 
hospitals  where  mixed  cases  are  taken 
it  is  considered  wise  to  provide  separate 
delivery  rooms  for  the  different  classes. 

Patients'  Rooms.  If  open  wards  are 
used,  it  is  well  to  have  them  small ;  or,  if 
the  ward  is  large,  subdivided  by  fixed 
screens.  A  certain  number  of  private 
rooms  should  be  provided,  and  perhaps 
a  few  suites  with  baths.  The  finish  and 
detail,  toilets,  sinks,  baths,  etc.,  should 
be  similar  to  those  of  the  surgical  wards 
of  the  hospital. 

Airing  balconies  should  be  provided  as 
in  the  medical  and  surgical  wards,  or 
solaria  can  be  added  if  found  desirable. 

There  should  be  opportunity  for  the 
isolating  of  the  occasional  cases  which 
may  be  infected.  A  simple  suite  of  two 
rooms  and  a  bath,  which  will  serve  as  a 
general  utility  room,  should  be  arranged 
on  a  separate  corridor  entered  from  the 
main  corridor,  and  with  an  outside  en- 
trance as  well,  if  possible.  This  arrange- 
ment will  give  opportunity  for  such  iso- 
lation but  will  not  prevent  th^  use  of 
these  rooms  for  regular  work.  The 
rooms  should  be  treated  and  equipped 
the  same  as  isolation  wards  for  con- 
tagious cases. 

Creche  or  Nursery.  The  nursery 
should  be  light,  well-ventilated,  cheerful 
and  warm,  and  well  away  from  the 
mothers.  There  should  be  not  only  space 
for  a  separate  bassinet  for  each  baby,  but 
a  separate  room  for  bathing  and  dress- 
ing. A  balcony  should  connect  with  thfs 
room,  so  that  the  babies  may  be  easily 


OF  THE  TWENTIETH  CENTURY 


81 


kept  out  of  doors  in  suitable  weather. 
Linen  closet,  blanket  warmer,  linen 
dryer,  etc.,  should  be  planned.  If  the 
department  is  large  a  creche  may  be  pro- 
vided for  ward  babies  and  another  for 
those  belonging  to  private  patients. 

A  few  concrete  examples  will  serve  to 
illustrate.  In  the  Nezuton  Hospital  ( Fig. 
403),  Newton,  Mass.,  the  maternity  serv- 
ice is  cared   for  in  a  building   recently 


On  the  third  floor  are  the  delivery 
rooms  for  ward  and  for  private  patients, 
with  sterilizing  room  between.  A  nurses' 
duty  room,  guests'  rooms,  isolating  room, 
toilets  and  storeroom  complete  this  floor. 
The  Talitha  Cwni  Maternity  (Fig.  408  j 
Jamaica  Plain,  Mass.,  is  an  institution  for 
unfortunate  girls.  The  waiting  depart- 
ment is  larger  than  the  hospital  proper, 
and  is  arranged  as  an  industrial  home. 


Key 

A  Airing  B<<^LCONr 

.!>     NUR.SI.'6  "R-OOMi 
C.   NuB-^r'V  .SiTTiNC  Room 
T>  PmvATE.    Wards 

E   0TOH.E.     Cuo^tT" 
F    BR-OOM    CuOiE-T 
6    T01)-tT 

H      Ell.ANKE.Ti    AND    LiNI-N 
1     LABORATOR-TT 
J    NUR.SE5  Room    Isolation  .Suite. 
K.   T  o  I  l_  E.  T 

L   Patient  "  • 

M  Diet    Kitchcn 
N    Elevator- 

O    COVER-B-P     POTtCrt 

P    COR.R.1COR.    And    iOLAK.IUM 


H0.5PITA1-       Pavilion 

Talitha     Cumi    Mateilnity   Home 
Jamaica  Plain      Ma55, 

EUV^-AliD    F.  .5TE.VEN.5,  AeCHITECT   'BoJTON   MAi3. 

FIG.  ni. 


I  Ke-y 

A    AiB-i^o  Balcony 

Z)      WAR.DS 

C     <5T0RE.     CLOiET 

D   Clothing  TLooKi 
E.   Linen 

F    To  1  l_  E  T 

Cr    'B.Li^'NKET    WA-EM 

H   Btj-oom    Closet 
1   PELivEie.-j-  -Rooin 

J  5TEB.lLlZ(N<i  .. 
K,  Pi  ET  K.1TCHEM 
L     EU&YA.TO-K. 

M   PocTOR.5  Room 


Hospital      Pavilion 
Talitha     Cumi     Maternity    Home 

Jamaica  Tlain      Ma.5.5. 
Edyvarb    f   .5TEVEN.3  Architect    BoiTOM  Ma53. 


FIG.    112. 


erected  in  memory  of  the  founders  of  the 
institution.  This  building  is  connected 
with  the  main  group  by  an  underground 
passage,  and  on  the  first  floor  by  an  open 
corridor. 

The  public  ward  is  on  the  first  floor, 
together  with  four  private  rooms.  There 
are  baby  rooms,  diet  kitchen,  toilets, 
linen  and  medicine  closets. 

The  second  floor  is  devoted  to  private 
rooms.  The  creche  is  on  the  south,  with 
its  own  airing  balconv. 


In  this  building  are  the  offices  of  the  in- 
stitution, the  kitchen,  and  dining-rooms. 
The  hospital  proper  is  connected  with  the 
waiting  department  by  a  closed  corridor. 
On  the  first  floor  of  the  hospital  build- 
ing- (Fig.  Ill)  is  a  six-bed  ward,  three 
private  rooms,  and  an  isolating  suite  so 
arranged  that  the  doors  leading  into  the 
corridor  can  be  closed  and  the  suite 
reached  from  the  service  staircase  and 
from  out-of-doors.  There  are  toilets, 
bath,  linen  room,  diet  kitchen,  and  creche 


82 


THE  AMERICAN  HOSPITAL 


on  this  floor.     An  airing  balcony  and  a 
solarium  afford  outdoor  facilities. 

The  second  floor  (Fig.  112)  is  similar, 
except  that  the  delivery  rooms  replace 
the  isolating  suite.  There  are  two  deliv- 
ery rooms  connected  by  the  sterilizing 
room,  and  a  doctors'  room  across  the  hall. 
The  delivery  rooms  are  cut  off  from  the 
patients'  part  of  the  hospital  by  double 
doors. 


Meadville  Hospital,  Meadville,  Penn., 
has  a  separate  pavilion  for  the  maternity 
service  (Fig.  113).  This  pavilion  is  at 
the  extreme  end  of  a  group  of  buildings. 
It  is  two  stories  in  height,  with  elevator. 

There  is  but  one  public  ward,  the  re- 
mainder of  the  patients  being  in  private 
rooms.  On  the  first  floor  is  an  isolation 
suite  and  a  nurses'  office.  The  delivery 
room,    sterilizing    room,    doctors'    room, 


•MAirfiBEITT-  PAVILIOH  • 
•MtAOVILLE-ClTY-  M05PITAL- 

■MEADVILLE'    PENN- 
•EDWARD    P-STEVEhJS  •ARCHITECT 

•BOSTON      •      MASS- 
FIG.  113. 
f 


OF  THE  TWENTIETH  CENTURY 


83 


o  S 
a  -^ 

n  < 

o  2 
z  S 

n  f^ 

w 

i 
w 

u 

w 


84 


THE  AMERICAN  HOSPITAL 


FIG.   lis.    MATERNITY  OPERATING  ROOM— BRIDGEPORT   (CONN.)    HOSPITAL. 
Edward    F.    Stevens,    Architect. 


etc.,  are  on  the  second  floor.  Each  floor 
has  a  creche,  which  contains  an  unusual 
feature,  a  fireplace.  There  are  the  usual 
airing  balconies  and  a  solarium. 

In  the  maternity  department  of  the 
Bridgeport  Hospital  (Figs.  44  and  45) 
the  ward  unit  is  somewhat  different  from 
that  of  any  of  the  other  hospitals  men- 
tioned in  this  chapter.  In  the  main  six- 
teen-bed  ward  the  principle  adopted  in 
the  Rigs  Hospital  is  introduced — that  is, 
there  are  four  groups  of  four  beds  each, 
and  these  groups  are  divided  by  station- 
ary glazed  screens  six  feet  in  height, 
giving  the  semi-isolation  needed  in  these 
rooms. 

The  creche  (Fig.  114),  as  well  as  the 
serving-kitchen  and  sink-room,  is  at  a 
distance  from  the  ward  and  private-room 
patients. 

In  this  plan  an  admitting  unit  is  pro- 
vided, in  which  the  careful  examination 
and  bathing  of  patients  are  conducted. 
Adjoining  this  admitting  unit  is  the  isola- 
tion unit,  in  which  any  suspicious  case 
can  be  kept  for  observation.     This  isola- 


tion department  is  connected  with  the 
serving  kitchen  of  the  children's  depart- 
ment by  a  slide.  Directly  under  the  slide 
is  the  dish  sterilizer,  the  cover  of  which  is 
controlled  from  both  sides  of  the  parti- 
tion, so  that  the^  infected  china  can  be 
returned  through  the  dish  sterilizer. 

The  children's  ward  unit  in  this  build- 
ing is  similar  to  the  maternity  ward  unit, 
except  that  the  screens  are  of  clear  glass, 
permitting  the  nurse  on  duty  to  have 
close  observation  of  all  the  children  and 
still  affording  the  necessary  isolation. 

The  maternity  department  of  the  Ohio 
Valley  General  Hospital  (Fig.  77)  is  sit- 
uated at  the  end  of  one  of  the  wings  and 
consists  of  wards  and  private  rooms,  two 
delivery  rooms,  a  creche,  and  waiting 
room.  Cases  needing  isolation  are  taken 
to  the  isolating  department  in  the  same 
building. 

At  the  St.  Luke's  Hospital  (Figs.  116 
and  117),  New  Bedford,  this  service  is 
taken  care  of  in  a  separate  building,  with 
a  nearly  ideal  arrangement  of  rooms  and 
service. 


OF  THE  TWENTIETH  CENTURY 


85 


FIG.  116.    ST.  LUKE'S  HOSPITAL,  NEW  BEDFORD.    MATERNITY  DEPARTMENT. 
Edward   F.   Stevens,  Architect. 


FIG.   117.    ST.    LUKE'S   HOSPITAL,   NEW   BEDFORD.    MATERNITY  DEPARTMENT. 

Edward    F.    Stevens,   Architect. 


86 


THE  AMERICAN  HOSPITAL 


Placed  at  the  extreme  end  of  the  group 
and  adjoining  the  ambulance  entrance  of 
the  operating  department,  the  admitting 
serv'ice  is  simple.  The  staff  sitting-room 
at  this  point  makes  a  special  waiting- 
room  unnecessary.  There  is,  however,  a 
husbands'  waiting-room  provided  for  the 
anxious  fathers-to-be. 

The  admitting  room,  with  entrance 
bath,  adjoins  the  delivery  corridor.  There 
are  three  delivery  rooms  for  the  three 
services — public,  semi-private,  and  pji- 
vate. 

The  public  wards,  two  of  eight  beds 
each,  accommodate  the  only  patients  on 
the  first  floor,  except  the  occasional  iso- 
lated case,  access  for  which  is  from  a  sep- 
arate corridor.  These  ward  beds  are 
separated  into  groups  of  four  by  screens, 
upon  which  are  located  the  nurses'  calls 
and  bedside  lights. 

The  Chicago  Lying-in  Hospital  (Figs. 
120  and  121)  is  planned  on  the  broad, 
generous  basis  of  the  comfort  of  the  pa- 
tient, the  isolation  of  sound,  and  the  con- 
venience of  management.  The  nurses' 
station,  located  as  it  is  at  the  crossing  of 
the  corridor  at  the  elevator  entrance, 
makes  possible  the  easy  surveillance  of 
the  entire  floor.    The  nursery  and  service 


rooms  are  placed  with  regard  to  care  and 
easy  service. 

On  the  sixth  floor  (Fig.  121)  are  lo- 
cated the  operating  section,  the  birth  and 
labor  rooms,  so  placed  as  to  allow  the 
utmost  flexibility  of  service  and  at  the 
same  time  the  utmost  privacy  when  pri- 
vacy is  required. 

The  sterilizing  and  nurses'  room  is  cen- 
trally located.  There  is  a  waiting  room 
for  the  husband  and  expectant  father. 

The  Wesson  Maternity  Hospital  (Figs. 
122-125)  consists  of  three  fireproof 
buildings  and  is  a  complete  hospital  unit. 
The  plans  of  the  patients'  pavilion, 
nurses'  home,  and  power  plant,  show  the 
general  relation  of  one  department  to  the 
others. 

The  maternity  department  of  the  Yon- 
kers  Homeopathic  Hospital  at  Yonkers, 
N.  Y.  (Figs.  126-130),  is  a  self-contained 
building  of  fireproof  construction.  It  is 
used  for  clean  surgical  cases  as  well  as 
for  obstetrical  service,  and  contains  the 
administration  offices  and  the  superin- 
tendent's living  apartments. 

For  smaller  units  in  private  hospitals 
see  plans  of  Macon  Hospital  (Fig.  55a), 
Melrose  Hospital  (Fig.  252),  and  San 
Francisco  Hospital  (Fig.  118). 


FIG.    118.    SAN    FRANCISCO    HOSPITAL.    MATERNITY    WARD. 
Newton    J.    Tharp,    Architect. 


1.  Patients'    waiting    room. 

2.  Doctors'  dressing-  room. 

3.  Isolation  room  No.  1. 

4.  Isolation  room  No.  2. 

5.  Diet   kietchen. 


6.  Delivery  room. 

7.  Nursery. 

8.  Toilet. 

9.  Ward. 
10.  Nursery. 


11.  First  stage  room. 

12.  Toilet. 

13.  Nurses'  Supplies. 

14.  Laboratory. 


OF  THE  TWENTIETH  CENTURY 


87 


88 


THE  AMERICAN  HOSPITAL 


2 
< 
1-1 

Pi 
O    w 

o  -^ 


u^ 


1-1  J! 
<  S 


2;'J 


t  3  n  iini       s     I 


OF  THE  TWENTIETH  CENTURY 


89 


h      ■      ■      « 
NuaswffcM/ 


FIG.    122.    WESSON   MATERNITY   HOSPITAL,    SPRINGFIELD,   MASS.     FIRST    FLOOR   PLAN. 
Kendall,  Taylor   &  Stevens,  Architects. 


FIG.  123.    WESSON  MATERNITY  HOSPITAL.  SPRINGFIELD,  MASS.    SECOND  FLOOR  PLAN. 
Kendall,  Taylor   &  Stevens,  Architects. 


90 


THE  AMERICAN  HOSPITAL 


3L5 


FIG.    124.    WESSON   MATERNITY   HOSPITAL,    SPRINGFIELD,    MASS. 
THIRD    FLOOR    PLAN. 

Kendall,  Taylor   &  Stevens,  Architects. 


KcsJ./Jnraa 


FIG.    125.    WESSON   MATERNITY   HOSPITAL,    SPRINGFIELD,    MASS. 

FOURTH  FLOOR  PLAN. 

Kendall,  Taylor  &  Stevens,  Architects. 


OF  THE  TWENTIETH  CENTURY 


91 


fiRST     Floor 


Second   Tloor. 


FIGS.    126   AND    127.    FLOOR   PLANS-YONKERS   HOMEOPATHIC   HOSPITAL,   YONKERS,   N.    Y. 
Kendall,    Taylor   &   Stevens,   Architects. 


92 


THE  AMERICAN  HOSPITAL 


FIGS.   128  AND   129.    FLOOR  PLANS— YONKERS  HOMEOPATHIC  HOSPITAL,   YOXKERS,   N.  Y. 
Kendall,  Taj'lor  &  Stevens,  Architects. 


OF  THE  TWENTIETH  CENTURY 


93 


94 


THE  AMERICAN  HOSPITAL 


'A   LITTLE    CHILD    SHALL   LEAD   THEM." 


OF  THE  TWENTIETH  CENTURY 


95 


CHAPTER  VII. 


Cfjilbren's;  Jlosipitals; 


In  planning  for  a  children's  hospital 
or  a  children's  department  of  a  general 
hospital  we  have  new  conditions  that 
do  not  exist  in  any  of  the  other  depart- 
ments, for  we  are  dealing  with  sus- 
picious cases  where  the  only  logical  treat- 
ment is  to  consider  every  case  as  having 
been  exposed  to  some  contagious  dis- 
ease and  to  provide  proper  isolation  for 
the  study  of  every  patient.  To  that  end 
the  admitting  department  should  have  a 
sufficient  number  of  subdivisions  so  that 
each  case  may  be  temporarily  isolated 
until  a  careful  diagnosis  can  be  made. 
During  the  usual  period  of  incubation 
the  children  should  be  placed  in  an  ob- 
servation ward,  with  the  beds  so  sep- 
arated by  screens,  or  otherwise,  as  to 
prevent  the  contact  of  one  patient  with 
another.  These  screens  may  be  made  of 
glass,  or  glazed  cubicles  can  be  provided 
that  will  give  segregation  and  the  neces- 
sary isolation. 

Where  a  children's  department  is 
placed  in  a  general  hospital,  be  the  de- 
partment ever  so  small,  it  should  be  sep- 
arated from  that  portion  of  the  hospital 
occupied  by  adults,  which  should  be  as- 
sured freedom  from  the  noises  coming 
from  the  children's  ward  and  safety 
from  the  danger  of  infection. 

The  necessity  of  providing  private 
rooms  is  not  so  great  in  the  children's 
hospital  as  in  the  adults',  for  it  is  found 
that  children  are  much  happier  if  they 
can  be  with  others,  as  their  attention  is 
taken  from  themselves  and  they  are 
likely  to  forget  their  own  discomfort  in 
seeing  the  discomfort  of  others.  Even 
in  the  general  wards,  however,  outside 
of  the  observation  ward,  a  certain  segre- 
gation or  grouping  is  desirable.  A  glass 
screen  partition  between  every  three  or 
four  beds  gives  a  sufficient  amount  of 
separation,  but  it  is  not  desirable  to  have 
wards  larger  than  from  sixteen  to 
twenty  beds. 


As  with  the  adult,  every  ward  unit 
should  be  supplied  with  one  or  two  quiet 
rooms  for  the  very  sick.  These  rooms 
can  be  glazed  so  that  the  nurse  from  the 
corridor  may  watch  the  patient  without 
the  necessity  of  entering  the  room. 

One  of  the  essentials  in  a  children's 
ward  unit  is  the  day  room  or  play  room, 
for  in  this  the  little  convalescents  are 
freer  to  romp  as  much  as  their  infirmi- 
ties will  allow  and  to  gather  what  com- 
fort they  can  from  the  toys  furnished 
them.  The  floor  covering  of  this  room 
should  be  some  warm  material — linoleum 
or  cork  carpet,  for  instance,  or  even  cork 
tile. 

The  serving  kitchen  and  sink  room 
should  be  very  little  different  from  those 
provided  for  the  adult  ward  units.  The 
toilet  and  bath  facilities,  however,  should 
be  entirely  different.  The  waterclosets 
should  be  low  and  easily  accessible.  For 
bathing,  the  shallow  tub  or  slab  tub  af- 
fords the  most  convenient  method  of 
washing  children.  Without  undue  ef- 
fort on  the  part  of  the  attending  nurse 
the  children  can  be  washed  in  clean  run- 
ning water  through  a  spray  attached  to 
a  rubber  hose.  The  temperature  of  the 
water  can  be  controlled  either  by  a  con- 
trol device  or  by  a  large  storage  tank 
placed  directly  above  the  bathing  slab. 
By  using  this  method  the  patient  is  never 
washed  in  dirty  or  poisoned  water,  as  is 
the  case  in  bathing  in  a  filled  tub.  (See 
Chapter  XV,  "Plumbing.")  In  this  bath- 
ing room  should  be  placed  a  cabinet  for 
the  toilet  articles  of  each  individual  child. 
This  should  be  divided  into  compart- 
ments and  should  contain  the  usual  mug, 
tooth  brush,  comb,  and  hair  brush. 

A  simple  device  to  hold  the  toilet  arti- 
cles of  the  children,  devised  by  Mr.  Bar- 
tine.  Superintendent  of  the  Ruptured 
and  Crippled  Children's  Hospital  in  New 
York,  may  be  hung  on  the  end  of  each 
bed.     This   contains  not  onlv  the  toilet 


96 


THE  AMERICAN  HOSPITAL 


articles,  but  the  towel  also.  Of  course 
this  necessitates  the  taking  of  these  arti- 
cles to  the  toilet  room  when  they  are  to 
be  used. 

The  prevalence  of  contagious  diseases 
in  a  children's  hospital  is  so  much  greater 
than  in  the  hospital  of  the  adult  that  h 
is  desirable  to  have  a  section  of  the  hos- 
pital planned  and  set  apart  for  the  care 
of  such  diseases.  This  department 
should  be  treated  the  same  as  the  con- 
tagious hospital — that  is,  there  should  be 


children  can  sometimes  be  quieted  more 
easily  by  pictures  on  the  walls  than  in 
any  other  way.  Simple  illustrations 
from  Mother  Goose,  stenciled  at  a  con- 
venient height  for  the  children  to  look  at, 
IS  one  way  of  providing  for  this.  One 
of  the  most  attractive  wards  which  the 
writer  has  ever  seen  was  in  the  children's 
department  of  the  St.  Thomas  Hospital 
in  London  (Fig.  132).  Here  the  walls 
were  lined  the  entire  height  wath  tiles 
depicting   interesting    incidents    in    child 


FIG.     132.    ST.     THOMAS'     HOSPITAL,     LONDON.    CHILDREN'S     WARD. 


a  certain  number  of  cubicles  or  rooms 
where  each  individual  bed  is  screened, 
and  the  same  care  maintained  in  the  treat- 
ment of  cases  as  in  the  contagious  hos- 
pital. 

Here  the  orthopedic  service  is,  as  a 
general  thing,  greater  than  in  the  hos- 
pital for  adults,  and  it  is  decided  econo- 
my, if  the  hospital  is  large,  to  have  a  de- 
partment for  the  manufacture  of  cor- 
rective apparatus,  as  is  well  illustrated 
in  the  Hospital  for  Sick  Children  in 
Toronto  and  in  the  Ruptured  and  Crip- 
pled Children's  Hospital  in  New^  York, 
which  will  be  mentioned  later  in  this 
chapter. 

The  requirements  for  operating  rooms 
and  surgical  dressing  rooms  do  not  differ 
from  those  described  in  the  chapter  on 
the  ward  unit. 

The  question  of  color  and  decoration 
is  one  which  requires  careful  study.   The 


life.  The  admitting  room  of  the  ForsytJi 
Dental  Clinic  (Figs.  133  and  134)  in 
Boston  is  another  good  example  of  cer- 
amic decoration. 

A  few  examples  of  children's  hospitals 
and  departments  will  serve  to  illustrate 
some  of  the  points  which  are  mentioned. 

In  the  children's  clinic  of  the  Dussel- 
dorf  Hospital,  at  the  entrance  is  a  small 
hospital  isolation  department  of  four 
beds,  for  the  observation  of  doubtful 
cases.  The  ground  floor  is  for  the  ac- 
commodation of  infants  and  has  an  in- 
teresting incubator  department  consisting 
of  six  cells  or  tiny  rooms,  each  for  t\\o 
cots.  The  lower  portion  is  constructed 
of  marble  and  the  upper  of  two  layers  of 
glass,  with  elaborate  apparatus  for  con- 
trolling the  temperature,  humidity  and 
ventilation  of  each  cell  from  the  corridor. 
The  utensils  are  contained  in  glazed  com- 
partments at  the  head  of  each  bed.    The 


OF  THE  TWENTIETH   CENTURY 


97 


FIG.  133.    FORSYTH  DENTAL  INFIRMARY,  BOSTON.    CERAMIC  FRIEZE  IN  WAITING  ROOM. 

Edward    P.    Graham,    Architect. 


first  floor  of  the  clinic  contains  the  wards 
for  the  older  children. 

The  Harriet  Lane  Home  for  Invalid 
Children  (Fig.  135  and  Fig.  136)  (the 
children's  department  of  the  Johns 
Hopkins  Hospital),  planned  by  Mr. 
Charles  Butler  of  New  York  (in  col- 
laboration with  Wyatt  &  Nolting  of  Balti- 


more), to  whom  the  writer  is  indebted 
for  the  data,  is  worked  out  most  care- 
fully to  provide  for  proper  observation 
and  segregation.  This  plan  consists  of 
the  main  building,  with  three  small  ward 
units.  The  patient  enters  through  the 
main  admitting  room,  with  the  examin- 
ing rooms   adjoining.      Suspicious  cases 


FIG.  134.    FORSYTH  DENTAL  INFIRMARY,  BOSTON.    CERAMIC  FRIEZE  IN  WAITING  ROOM, 


98 


THE  AMERICAN  HOSPITAL 


CORRIDOR    It; 
KAfN    HOIPITAJ- 


•  First  •  floor  •  plan 


FIG  135.    HARRIET  LANE  HOME  FOR  INVALID  CHILDREN. 
Wyatt  &  Nolting,  Butler  &  Rodman,  Associated  Architects. 


OF  THE  TWENTIETH  CENTURY 


99 


FIG.  136.    JOHNS  HOPKINS  HOSPITAL.     HARRIET  LANE  HOME  FOR  INVALID  CHILDREN. 
Wyat*    &  Nolting-,   Butler   &  Rodman,   Associated   Arcliitects. 


FIG  138.    HOSPITAL  FOR  SICK  CHILDREN,  TORONTO,  CANADA.    ISOLATION  PAVILION. 

Stevens  &  Lee,  Architects. 


100 


THE  AMERICAN  HOSPITAL 


are  admitted  through  what  is  termed  the 
infectious  waiting-room,  and  one  of  the 
three  wards  provided  is  for  observation 
purposes.  In  this,  each  bed  is  screened 
from  its  neighbor  by  a  close  glass  and 
metal  screen.  Each  of  these  ward  units 
contains  a  duty  room,  sink  room,  bath 
room,  isolation  room,  and  a  serving 
kitchen  with  nurses'  dining-room  adjoin- 
ing. 

Perhaps  no  children's  hospital  in  this 
part  of  the  world  is  doing  greater  work 
than  The  Hospital  for  Sick  Children,  at 
Toronto,  which  administers  more  to  poor 
children  than  to  the  children  of  the  rich, 
both  in  the  outdoor  and  in  the  indoor  de- 
partments, as  well  as  in  the  summer 
Lakeside  Home. 

The  isolation  building  (Figs.  137  and 
138)  of  this  group  is  planned  particular- 
ly for  the  care  of  an  epidemic  and  for 
small  children.  It  is  designed  on  the 
principle  of  the  Pasteur  Hospital  in 
Paris,  and  will  be  described  in  detail  in 
the  chapter  on  contagious  hospitals.  It 
provides  for  absolute  isolation  of  sus- 
pected cases,  or  contagious  cases  as  they 
develop.  A  separate  entrance,  separate 
elevator,  and  a  separate  corps  of  nurses 
are  provided  for  this  section  of  the  hos- 
pital. 

This  hospital  carries  on  a  very  large 
out-patient  clinic.  (See  plan  Out  Patient 
Department,  Fig.  229).  The  original 
hospital  has  been  remodeled,  airing  bal- 
conies and  day  rooms  added,  and  the 
wards  opened  up  and  brought  into  the 
sunlight. 

One  department  of  this  hospital  which 
probably  no  other  hospital  of  its  size  has 
is  the  complete  plant  for  the  pasteuriza- 
tion and  modification  of  all  milk  not  only 
for  the  hospital  but  for  a  very  large  out- 
patient distribution.  This  department 
has  the  most  modern,  up-to-date  equip- 
ment. 

Two  or  three  examples  of  children's 
departments  in  general  hospitals  will 
illustrate  some  of  the  points  suggested  in 
the  preceding  paragraphs. 

In  a  ^small  hospital  in  Melrose,  Mass. 
fFig.  253),  the  children's  department,  al- 
though very  small,  is  separated  from  the 
main  corridor  by  two  glazed  doors.  The 
ward    (Fig.    144)    is    connected    with    a 


a 


^ 


Ui  0 


H 

n 

(5 


.52 


OF  THE  TWENTIETH  CENTURY 


101 


FIG.  139. 


CHILDREN'S  WARD— MATERNITY  BUILDING,  BRIDGEPORT   (CONN.)   HO.SPITAL. 
Edward   F.   Stevens,  Architect. 


large  outside  airing  balcony  and  is  pro- 
vided with  special  children's  toilet,  and 
a  small  isolation  room  with  glazed  walls 
for  better  observation  is  provided. 

In  the  children's  department  of  the 
Bridgeport  Hospital  (Fig.  139)  eighteen 
children  are  cared  for  in  the  main  ward. 
This  ward  is  sub-divided  by  glazed 
screens  into  groups  of  four  or  five  beds 
each,  the  glazed  screens  permitting  per- 
fect supervision.  A  small  isolation  room 
is  provided  for  one  or  two  more  patients. 
A  large,  well-lighted  day  room  (Fig. 
140),  ample  airing  balcony,  and  complete 
service  rooms,  including  serving  kitchen, 
sink  room,  surgical  dressing  room,  bath- 
ing room,  and  toilets,  are  provided. 

The  simple  decoration  on  the  walls  of 
the  main  children's  ward,  depicting 
mountain  scenery,  and  a  large  memorial 
window  add  to  the  color  effect  of  this 
department. 

Adjoining  the  children's  department  is 
a  small  infectious  department,  consisting 
of  two  isolation  rooms  and  an  isolation 
toilet.  This  isolation  department,  while 
adjoining  the  children's  department,  can 
be  entirelv  shut  ofit  and  served  from  a 


cross  corridor  connecting  with  the  ad- 
mitting department. 

Another  good  example  of  a  children's 
ward  building  is  shown  in  the  plans  of 
the  children's  pavilion  of  the  Worcester 
City  Hospital  (Fig.  145,  146).  The  wards, 
the  private  rooms,  and  the  utilities  are 
grouped  around  a  central  rotunda  in  such 
a  way  that  surveillance  is  easily  kept  of 
every  portion  of  the  floor.  Here  the 
natural  system  of  ventilation  is  used — 
i.e.  ventilating  the  entire  wards  from  the 
center  of  the  ceiling,  which  slopes  at  an 
angle  of  at  least  thirty  degrees.  This 
construction  is  well  hidden  in  the  exterior 
treatment. 

In  the  plans  for  the  Hospital  for  Rup- 
tured and  Crippled  (Figs.  141-143),  New 
York  City,  a  most  comprehensive  scheme 
is  carried  out.  This  service  is  largely  for 
children  and  the  planning  is  simple  and 
straightforAvard  as  the  outpatient  sec- 
tion, consisting  of  thoroughly  equipped 
rooms  and  departments,  is  entered  on  the 
left  of  the  center  while  a  corresponding 
entrance  on  the  right  enters  the  execu- 
tive department. 

In  the  basement  are  the  kitchen,  the 


102 


THE  AMERICAN  HOSPITAL 


o 
u 

H 

O 

Ph 

w 
o 

Q 

m 
I 

Q 
PS 

< 

^5 


C/} 


1/1 


OF  THE  TWENTIETH   CENTURY 


103 


lJ 


•  PLAN     OF-  Fl^ST  •   FLOOK- 

H05P1TAL- JOR.-THL-P.LL1LF-OF  •  TH  L  •  t\-V  P  TV  FLLD-AND- C  K.1  PPL  L  D 


f  I  ^     A  «.CH 


FIG.   141. 


laundry,  the  heating  plant,  the  brace 
shop,  and  storage  for  supplies. 

On  the  first  floor  are  the  out-patient 
department  and  the  administration  de- 
partment. 

The  second  floor  contains  the  living 
quarters  for  the  superintendent,  stafl:, 
housekeeper,  and  graduate  nurses. 

On  the  third  floor  are  the  wards  for 
girls  and  female  adults,  together  with 
dining-rooms  for  patients. 


The  fifth  floor  plan  is  similar,  except 
that  the  operating  department  is  here 
located. 

The  fifth  floor  contains  the  class  and 
school  rooms  and  the  large  assembly  halls 
for  the  children,  while  on  the  sixth  are 
the  great  out-of-door  wards  and  so- 
lariums. 

The  color  scheme  throughout  is  most 
pleasing  and  is  most  artistically  carried 
out. 


104 


THE  AMERICAN  HOSPITAL 


A     i     ~        •5i"iTf^Ll 


PLA:i   C7    FOV.VrH   FLOOi^ 
HOSPITAL-  FOP^-THL-iU-LlLI-OF-THL-P^VPTViUD  AND-C.WPPLED 


FIG.   142. 


OF  THE  TWENTIETH   CENTURY 


105 


FIG.  113. 


106 


THE  AMERICAN  HOSPITAL 


FIG.   1-14.    MELROSE  HOSPITAL.    CHILDREN'S  WARD. 


FIG.   146.     WORCESTER  CITY   HOSPITAL,  CHILDREN'S   BUILDING.    ENTERIOR. 
Fuller  &  Delano,  Architects. 


OF  THE  TWENTIETH   CENTURY 


107 


P 


?3  'PJ^ 


4--I 


I 


m 


n 


h^^. 


t        «  .     -»^' 


•        *  _-    • 


M  * 


•  9 


FIG.    145.    WORCESTER    CITY    HOSPITAL,    CHILDREN'S    BUIEDING.      FLOOR    PLAN. 
Fuller   &  Delano,  Architects. 


108 


THE  AMERICAN  HOSPITAL 


CHAPTER  VIII. 


^fje  Contagious;  department 


In  all  the  large  general  hospitals  of 
Europe,  departments  for  the  care  of  in- 
fectious diseases  are  provided  and  gen- 
erally consist  of  separate,  detached 
buildings,  being  complete  units  and  di- 
vided into  small  wards  with  complete 
service  rooms  and  equipment.  Among 
those  which  are  particularly  interesting 
technically  are  those  at  Eppendorf,  Vir- 
chow,  West  End  Berlin,  and  Lindenberg- 
Cologne.  But  perhaps  no  hospital  in 
Europe  has  carried  the  newer  principles 
of  infection  to  a  higher  development  than 
the  Pasteur  Hospital  in  Paris. 


ceding  my  visit,  with  a  service  of  nearly 
five  thousand  cases,  showed  the  cross  or 
internal  infection  to  be  only  two  to  the 
thousand ! 

Friends  are  allowed  to  visit  the  pa- 
tients, communicating  with  them  from 
the  open  balcony  provided  for  the  pur- 
pose. This  balcony  extends  in  front  of 
all  rooms. 

In  an  interview  with  Dr.  Louis  Mar- 
tin, the  Director  of  the  Pasteur,  and 
from  his  book,*  "Hygiene  Hospitaliere," 
the  writer  gathered  the  following  facts : 
(a)   The  service  is  divided  into  two 


FIG.   150.     PASTEUR  HOSPITAL,   PARIS.     FLOOR  PLAN. 


When  in  1907  I  visited  the  Pasteur 
Hospital  for  the  first  time  and  saw  cases 
of  scarlet  fever,  measles,  diphtheria, 
sleeping  sickness,  and  other  communic- 
able diseases  side  by  side  in  one  build- 
ing, within  plain  view  of  the  nurse  and 
visitor  and  separated  from  each  other 
only  by  plate  glass  partitions,  I  was  very 
much  surprised.  My  training  had  been 
that  to  care  safely  for  contagious  cases 
one  must,  at  least,  have  separate  depart- 
ment, if  not  separate  buildings.  What 
was  my  greater  surprise  to  find  that  while 
these  various  diseases  were  in  the  same 
building  and  being  cared  for  by  the  same 
nurse,  the  record  of  the  five  years  pre- 


sections — that  for  the  very  ill  patients 
and  that  for  convalescents.  Between 
these  two  sections  are  the  service 
rooms  (Fig.  150)  and  fresh  air  pas- 
sages, so  that  the  patient  must  pass 
through  an  area  of  fresh  air  in  being 
transferred  from  one  department  to 
another. 

(b)  In  caring  for  all  cases,  the  nurse 
w^ears  a  special  gown  for  each  room  or 
cubicle,  never  removing  the  gown  from 
the  room  except  for  cleansing. 

(c)  After  handling  the  patient  or 
anything  which  the  patient  has  touched. 


*"Hygiene    Hospitaliere,"    J.    B.    Bailliere    et    Fils; 
Paris,    1917. 


OF  THE  TWENTIETH  CENTURY 


109 


FIG.  151.     FLOOR  PLANS- WHITE  ISOLATION  BUILDING,  ST.  LUKE'S  HOSPITAL 

JACKSONVILLE,    FLA. 
Edward   F.   Stevens,   Architect;    Mellen   C.   Greeley,   Associate  Architect. 


no 


THE  AMERICAN  HOSPITAL 


the  nurse  washes  her  hands  thoroughly, 
(d)   All  utensils  are  disinfected  by 
boiling  or  otherwise. 

This  is  Dr.  Martin's  description  of 
the  rooms: 

"The  partitions  of  the  room  are 
glazed  to  facilitate  surveillance  and  to 
render  isolation  less  irksome  to  the 
patient,  for  through  the  glass  parti- 
tions the  patient  remains  in  contact 
with  the  world  outside,  which  is  a 
great  comfort  to  him. 

"The  patient  in  his  room  ought  to 
be  sheltered  from  all  cross  infection, 
whether  it  be  from  the  hospital  or  from 
outside.  Everything  which  enters  the 
room  shall  be  sterile,  or  at  least  freed 
from  all  noxious  germs.  All  that 
leaves  his  room  must  also  be  sterilized." 
In  other  words,  the  laws  of  antisepsis 
and  aseptic  surgical  technique  must  be 
observed. 

On  these  principles  many  of  our  newer 
American  hospitals  for  contagious  dis- 
eases are  now  being  built.  The  theory 
is  that  none,  or  comparatively  few,  of 
the  communicable  diseases  is  transmitted 
other  than  by  contact,  and  the  best 
authorities  agree  that  true  air-borne  in- 
fection is  very  rare. 

We  should  then  plan  our  hospital  for 
communicable   diseases : 

1st — So  that  the  nurse  or  doctor, 
after  contact  with  the  patient,  can  have 
ample  and  immediate  opportunity  to 
scrub  the  hands. 

2nd — So  that  sterilizers  can  be  pro- 
vided for  sterilizing  every  article  that 
goes  to  the  patient  or  is  taken  from  tlie 
patient. 

3rd — So  that  provision  can  be  made 
for    the    removal    and    destruction    of 
waste,  either  by  local  incinerators  or 
properly  protected  receptacles  to  con- 
vey to  the  general  destroyer. 
Then  there  must  be  the  careful  observ- 
ance of  strictly  surgical  technique — i.e., 
as  in  the  surgical  case  the  area  around 
the  open  wound  is  clean,  unless  infected 
by   contact   with   some   unsterile   instru- 
ment,   or    unclean    hands,    so    the    area 
around  the  infected  patient  is  clean  un- 
less polluted  by  touch  or  contact  from 
the  patient   or   some   one   or   something 
which  the  patient  has  touched. 


Perhaps  no  man  in  this  country  has 
given  more  thought  and  study  to  this 
subject  than  has  Dr.  Chas.  V.  Chapin,* 
the  Providence,  R.  I.,  Health  Commis- 
sioner, ably  assisted  by  Dr.  D.  L.  Rich- 
ardson, Superintendent  of  the  Provi- 
dence City  Hospital.  Here  theory  is 
supplemented  by  actual  practice,  with 
wonderfully  satisfactory  results. 

In  this  hospital  one  will  see  in  rooms 
adjoining  one  another,  cases  of  scarlet 
fever,  diphtheria,  erysipelas,  and 
measles,  with  the  same  physicians  and 
the  same  nurses  administering  to  all,  the 
latter  eating  in  the  same  dining-room, 
living  in  the  same  nurses'  home  with 
nurses  of  other  departments  of  the  hos- 
pital. 

As  the  service  becomes  larger  or  the 
diagnosis  of  the  cases  surer,  then  the 
o-rouping  of  the  various  diseases  in  dif- 
ferent buildings  becomes  an  economy, 
but  the  technique  is  never  relaxed. 

One  of  the  best  planned  isolation 
pavilions  in  this  country  is  that  recently 
built  by  the  Department  of  Health  of  the 
City  of  New  York  at  the  Willard  Parker 
Hospital,  and  used  for  a  measles  build- 
ing (Fig.  156).  Here  on  the  ground 
floor  one  finds  the  best  form  of  cubicle 
system.  In  addition  to  the  special  sink, 
lights,  etc.,  each  cubicle  has  a  small  well- 
ventilated  toilet  room  entered  from  the 
room,  containing  a  watercloset,  making 
it  unnecessary  for  the  patient  to  leave  the 
isolating  room  until  he  is  convalescent  or 
discharged. 

The  admitting  pavilion  (Fig.  157)  of 
the  Kingston  Avenue  Hospital  of  the  De- 
partment of  Health,  City  of  New  York, 
is  well  planned,  providing  for  separate 
service  and  entrance  from  the  outside,  if 
necessary,  to  every  room  on  the  ground 
floor.  This,  too,  has  separate  toilets  for 
each  cubicle  or  room. 

The  contagious  department  of  the  St, 
Luke's  Hospital,  Jacksonville,  Florida, 
consists  of  separate  pavilions  for  white 
and  colored  (See  general  plan,  Fig.  7). 

The  plan  is  an  adaptation  of  that  of  the 
Pasteur  Hospital  of  Paris  (Fig.  150) 
and  does  away  with  all  the  cumbersome 
and  elaborate  arrangements  of  the  old 
school   (Fig.  151).     All  classes  of  con- 

*"Sources  and  Modes  of  Infection." 


OF  THE  TWENTIETH  CENTURY 


111 


_S%^-,-^--.Cv 


FIG.  152.    VIEW  OF  WHITE  ISOLATIOX  BriLlJl.\(;,  ST.   LIKES  HOSPITAL,  JACKSONVILLE,  FLA. 
Edward  F.  Stevens,  Architect;  Mellen  C.  Greeley,  Associate  Architect. 


cagious  diseases,  with  the  exception  of 
smallpox,  which  is  still  cared  for  at  a 
distance  from  other  people,  largely  on 
account  of  popular  prejudice,  are  treated 
in  one  building.  There  are  single  rooms 
for  fresh  cases  and  wards  for  convales- 
cents. The  rooms  are  cubicles,  with 
glass  partitions  for  ease  of  observation, 
each  cubicle  being  a  separate  entity,  com- 
plete in  itself.  Correct  technique,  the  so- 
called  "aseptic  nursing,"  prevents  the 
spread  of  infection,  but  facilities  must 
be  provided  for  carrying  it  out. 

The  central  portion  of  the  building  is 
the  administrative  department,  being 
occupied  by  the  admitting  and  discharge 
rooms  and  the  various  utilities,  with  the 
office  of  the  nurse  in  charge.  An  open 
air  cut-off  separates  this  from  the  part 
occupied  by  patients. 

Each  room  or  ward  is  furnished  with 
a  scrub-up  sink,  with  elbow  faucets,  so 
that  after  any  service  for  the  patient  the 
physician  and  the  nurse  scrub  and  disin- 
fect their  hands  before  leaving:  the  room. 


They  also  wear  gowns  while  caring  for 
the  patient,  leaving  them  on  hooks  in- 
side the  door  before  they  depart. 

The  equipment  consists  of  utensil  ster- 
ilizers, which  can  be  opened  by  the  foot ; 
elbow  handles  for  the  faucets  over  slop 
sinks ;  dish  sterilizers  large  enough  to 
take  a  tray  and  its  dishes ;  garbage  in- 
cinerators which  may  be  opened  by  el- 
bow ;  liquid  soap  dispensers  with  pedal 
action ;  lever  door  handles  which  can  be 
opened  by  elbow  or  upper  arm ;  and 
everywhere  scrub-up  sinks  with  elbow 
handles.  By  means  of  these  carefully 
worked  out  details  the  nurse  is  enabled 
to  care  for  a  patient,  dispose  of  all  waste 
material,  and  accomplish  the  disinfec- 
tion of  all  utensils  and  appliances  used 
in  the  process,  without  touching  anything 
else.  At  the  close  of  each  procedure  she 
sterilizes  her  hands  and  removes  her  in- 
fected gown,  becoming  clean  again,  to 
start  upon  the  same  round  with  another 
patient. 

AA'hen    a    patient    is    admitted,    he    is 


112 


THE  AMERICAN  HOSPITAL 


FIG.    153.    ST.    LUKE'S    HOSPITAL,    JACKSONVILLE.    ISOLATION    BUILDING. 
VIEW  IN  SINGLE  ROOM. 


FIG.    154.    ST.    LUKE'S    HOSPITAL,    JACKSONVILLE.    ISOLATION    DEPARTMENT. 
VIEW  IN  SERVING  KITCHEN. 


OF  THE  TWENTIETH  CENTURY 


113 


bathed  on  the  shallow  tub-slab  with  a 
spray,  so  he  gets  what  is  practically  a 
shower  bath  or  champoo  in  running 
water.  He  is  then  placed  in  a  single 
room.  When  convalescent,  he  is  trans- 
ferred to  the  small  ward  where  there 
may  be  other  patients  recovering  from 
the  same  disease.  This  ward  is  treated 
as  a  unit,  but  the  aseptic  technique  is 
still  carried  out. 

A  portable  tub  (Fig.  153),  similar  in 
principle  to  the  one  in  the  admitting  room 
but  made  of  wood  covered  with  copper 
for  lightness,  set  on  a  wheeled  stretcher 
frame  of  the  same  height  as  the  beds,  is 
also  provided.  This  may  be  taken  to  any 
room,  the  patient  transferred  to  it,  and 
bathed  with  a  spray  attached  to  the 
faucet  at  the  scrub-up  sink.  A  floor 
drain  in  each  room  receives  the  waste 
water  from  the  tub.  The  tub  is  disin- 
fected after  each  using. 

When  the  patient  has   recovered  and 


is  to  be  discharged,  he  is  taken  through 
the  open  air  corridor  to  the  discharge 
room,  given  a  cleansing  and  disinfecting 
bath,  and  passed  into  the  dressing  room, 
where  he  receives  his  own  uninfected 
clothing.  From  this  room  he  departs 
without  coming  into  contact  with  other 
persons  or  parts  of  the  buildings.  (See 
also  Figs.  153  and  154.) 

Hospital  finish  of  the  simplest  and 
strictest  sort  has  been  carried  out  in  these 
])avilions  and  everything  made  so  as  to 
be  easily  cleaned.  The  furniture  is  ex- 
tremely simple,  the  rooms  having  no 
more  than  a  bed,  a  comfortable  chair, 
and  a  table,  besides  the  all-important  sink 
or  lavatory.  These  sinks  were  made 
special,  being  provided  with  an  integral 
drain-board  upon  which  to  place  hand 
brushes  and  other  appliances. 

The  convalescent  wards  have  toilets 
directly  oiT  them,  and  each  has  its  own 
screened-in  porch. 


FIG.    ISS.    ST.    LUKE'S   HOSPITAL,    JACKSONVILLE.    ISOLATION   DEPARTMENT. 

THREE-BED   WARD. 


114 


THE  AMERICAN  HOSPITAL 


J 


FIG.    156.    WILLARD    PARKER    HOSPITAL,    NEW    YORK.      MEASLES    PAVILION. 


All  floors  are  of  cement,  painted. 
Washable  rugs  are  provided  for  the 
rooms  of  the  convalescents. 

Visitors  are  not  allowed  in  the  build- 
ing, but  there  is  a  narrow  balcony  run- 
ning in  front  of  every  room,  like  the 
Pasteur,  so  that  parents  and  friends  may 
come  to  the  patient's  window,  see  and 


talk  with  him,  and  know  how  he  is  get- 
ting on.  This  one  provision  probably 
does  as  much  as  any  one  thing  to  estab- 
lish confidence  in  a  contagious  hospital. 
Though  there  is  considered  to  be  no 
adequate  reason  why  the  nurses  caring 
for  contagious  cases  may  not  mingle  with 
other  nurses,  it  has  been  deemed  wisest, 


-{^l'^3 


•i£CONDnJXa-*LWJ  * 


FIG.    157.    KINGSTON    AVENUE    HOSPITAL,    BROOKLYN.     ISOLATION    PAVILION. 


OF  THE  TWENTIETH   CENTURY 


115 


ITTIIIIIIIII   I 


2cAi.e.     1iHjiti»«jJ" 


Fifth    Floor.  Plan 


EOWACD       F.       ■STE.VENi 

Ae-cmitect      Boston  Masj. 


FIG.  158.    PLAN  OF  FIFTH  FLOOR,  OHIO  VALLEY  GENERAL  HOSPITAL,  WHEELING,  W.  VA. 

Edward   F.    Stevens,    Architect. 


at  the  present  time,  to  house  them  in  the 
isolation  paviHon.  The  second  floor, 
therefore,  provides  single  rooms  for  six 
nurses,  with  bath,  etc.,  these  rooms  being 
fully  as  commodious  as  those  at  the 
nurses'  residence.  This  floor  has  a  sep- 
arate entrance,  through  one  of  the  open 
air  corridors. 

The  pavilion  provided  for  Avhite  per- 
sons has  rooms  for  patients  on  two  floors, 
one  accommodating  twenty  and  one 
eleven  patients.  Only  the  lirst  floor  is 
used  at  the  present  time,  the  ground 
floor  being  finished  but  without  equip- 
ment until  such  time  as  it  may  be 
needed. 

The  pavilion  provided  for  colored  per- 
sons accommodates  eleven  patients.  It 
is  an  exact  counterpart  of  the  adminis- 
tration portion  and  one  wing  of  the  white 
pavilion. 

If  the  theory  of  isolation  and  the  tech- 
nique of  care  is  correct,  then  infectious 
diseases  can  be  safely  cared  for  in  the 
general  hospital.     This  is  now  being  car- 


ried out  in  the  Ohio  Valley  General  Hos- 
pital. While  this  department  (Fig.  158) 
is  in  the  main  building,  it  is  nevertheless 
isolated  by  a  fresh  air  cut-off  from  the 
other  rooms  on  this  floor.  Se{)arate  serv- 
nig  kitchen  and  sink  room  are  provided 
as  well  as  every  facility  for  cleansing  the 
person  of  the  patient,  for  the  work  of  the 
nurse,  and  all  utilities.  The  nurse,  after 
thoroughly  cleansing  her  hands  and 
changing  the  department  gown,  mingles 
freely  with  the  other  nurses  of  the  hos- 
pital. 

The  isolation  unit  (Figs.  137,  138,  160) 
of  the  Hospital  for  Sick  Children,  Toron- 
to, Canada,  has  been  developed  on  the 
Pasteur  principle,  or  much  like  the  Isola- 
tion Department  of  St.  Luke's  Hospital 
at  Jacksonville,  with  air  cut-offs  between 
the  acute,  the  service,  and  the  convales- 
cent departments.  Each  cubicle  is  pro- 
vided with  the  sink  described  in  the 
Jacksonville  Isolation.  Food  is  delivered 
in  the  open  corridor  through  a  window 
to  the  serving  kitchen.     Under  this  win- 


116 


THE  AMERICAN  HOSPITAL 


FIG.  159.    ISOLATIOX  DEPARTMENT  CORRIDOR-OHIO  VALLEY  GENERAL  HOSPITAL, 

WHEELING,  W.  VA. 


FIG.  160.    HOSPITAL  FOR  SICK  CHILDREN.    ISOLATION  BUILDING.    VIEW  OF  INTERIOR. 


OF  THE  TWENTIETH  CENTURY 


117 


u 


H     . 
W  vx 

td  ^ 

H<  » 
^^   " 

o  ^"  .t; 

S  H  ^ 

o  a  < 

S  o  ^~ 
c/:  Pi  c 
H  PP    ^ 

u  o  u 

<§^ 

en  M  >v 

<  S  E-i 

^  en  „- 

^  12;  -a 

t^  "^  t4 

fc  H  "^ 

P? 
O 
O 


118 


THE  AMERICAN  HOSPITAL 


dow  is  the  dish  sterilizer,  the  cover  of 
which  is  controlled  from  either  side  of 
the  wall. 

Small  operating  rooms  are  provided  in 
each  story.  A  separate  staircase  is  also 
provided"  for  the  discharged  patients, 
leading  from  the  discharge  room  or  cross 
corridor. 


The  contagious  department  of  the 
Massachusetts  Homeopathic  Hospital  at 
Brighton  (Fig.  163)  provides  for  all 
classes  of  contagious  diseases.  The  plan 
consists  of  a  three  building  unit,  con- 
nected by  open  corridors.  The  general 
administration  building  is  in  the  center, 
flanked  bv  the  ward  units. 


OF  THE  TWENTIETH   CENTURY 


119 


CHAPTER  IX. 


^l)e  pgpcfjopatfjic  department  of  tf)e  (general  |^o£(pital 


Since  the  beginning  of  this  century,  no 
greater  development  has  been  made  in 
any  branch  of  hospital  housing  and  treat- 
ment than  in  the  psychopathic  and 
neurological  departments. 

Only  a  few  years  ago  the  person  who 
was  adjudged  insane  was  committed  to 
an  asylum ;  and  if  resistance  were  offered 
he  was  placed  in  irons  and  half  starved. 
The  mild  cases  were  herded  with  the  vio- 
lent— yes,  "herded"  is  a  good  name  for 
it — and  they  were  treated  more  as  beasts 
of  the  field  than  as  human  beings  whose 
course  of  thought  was  diverted  through 
some  slight  lesion.  The  scientific  study 
of  the  disturbed  patient  has  shown  that 
in  most  cases  the  modern  or  humane 
treatment  is  productive  of  the  greatest 
success ;  and  psychopathic  hospitals, 
either  as  independent  institutions  or  as 
departments  of  a  general  hospital,  are  be- 
ing considered  everywhere.  The  psycho- 
l^athic  hospital  then  becomes  a  clearing- 
house for  the  study  and  segregation  of 
cases. 

In  this  department  more  than  in  any 
other  in  the  hospital  is  it  essential  to  con- 
sider the  environment  of  the  patient ;  the 
interior  must  be  restful ;  there  must  be 
nothing  in  color  or  design  to  excite  the 
patient ;  the  surroundings  must  be  home- 
line,  with  as  little  of  the  institutional  ap- 
pearance as  possible.  Great  care  should 
be  used,  however,  to  avoid  giving  any 
opportunity  for  the  patient  to  inflict  per- 
sonal injury,  by  providing  non-projecting 
hardware ;  turned-down  door  handles : 
flush  transom  bars;  lighting  fixtures  out 
of  reach,  with  no  projections;  small 
lights  of  plate  glass  in  windows,  which 
never  open  enough  to  admit  the  body  of 
a  person ;  special  plumbing  fixtures,  firm- 
ly secured ;  and  cabinets  for  telephones 
and  service  built  into  and  not  projecting 
from  the  wall. 

One  of  the  earliest  institutions  to  rec- 
ognize  the   more    scientific   care   of    the 


mild  cases  was  the  "Psycluatrische 
Klinik"  at  Munich.  The  treatment  is 
humane.  No  force  is  used  with  the  pa- 
tients. If  they  are  incHned  to  be  unruly, 
they  are  persuaded  to  enter  the  contin- 
uous bath ;  if  they  ofifer  resistance,  a  mild 
hypodermic  is  given,  and  when  they  re- 
cover from  this  the  continuous  bath  keeps 
them  quiet.  So  the  bath  has  become  a 
great  factor  in  the  maintenance  of  peace 
and  quiet  in  what  was  once  called  the 
"mad  house." 

In  this  "Klinik"  (Figs.  170  and  171) 
one  hundred  and  fifty  patients  are  cared 
for,  divided  into  first,  second,  and  third 
classes,  according  to  the  service  and  ac- 
commodation. Every  class  is  provided 
with  special  visiting-day  rooms  wherein 
patients  may  receive  their  friends. 

Those  in  the  first  class  have  private 
rooms.  For  this  accommodation,  with 
services  of  nurse  and  doctor,  they  pay 
eleven  marks  ($2.75)  per  day.  Every 
attempt  is  made  to  make  the  apartments 
homelike,  and  no  visible  form  of  restraint 
is  noticed. 

The  second  class  patients  have  less 
luxurious  accommodations  but  have  com- 
fortable living  rooms  and  sleeping  quar- 
ters, for  which  they  pay  six  and  one-half 
marks  ($1.63)  per  day. 

The  third  class  patients  occupy  wards 
at  three  marks  ($.75)  per  day.  The 
wards  are  neat  and  well  kept,  and  toilets 
are  provided  in  every  ward  unit. 

The  details  of  construction  are  most 
carefully  worked  out.  The  door  frames 
are  of  iron,  w'ith  no  projection;  all  door 
handles  are  turned  down,  affording  no 
ay  to  cause  injury;  all  cabinets  are  of 
steel,  placed  flush  with  the  wall ;  the  tele- 
phones are  enclosed  in  cabinets,  and  sig- 
nal is  given  by  a  red  light,  no  bells  being 
used.  In  the  new  Psychiatric  Clinic  of 
the  State  University  of  Utrecht,  Holland 
(Figs.  172-176),  Professor  Heilbronner 
has  worked  out  some  excellent  ideas. 


120 


THE  AMERICAN  HOSPITAL 


2        r; 


OF  THE  TWENTIETH  CENTURY 


121 


122 


THE  AMERICAN  HOSPITAL 


FIG.    172.     PSYCHIATRISCH-XEUROLOGISCHE    KLIXIK,      UTRECHT.     GROUND    FLOOR. 


One  hundred  patients  are  accommo- 
dated and  all  are  placed  on  the  first  floor, 
which  is  divided  into  six  sections — three 
for  women  and  three  for  men — and  clas- 
sified according  to  condition. 

The  offices,  laboratories,  etc.,  are  lo- 
cated on  the  second  and  third  floors  of 
the  main  building. 

While  this  is  strictly  a  pavilion  type  of 


hospital,  all  sections  are  connected  by  a 
common  corridor,  adjoining  which  is  the 
working  or  domestic  side  of  the  institu- 
tion, the  kitchens,  dining-room,  together 
with  lecture  rooms,  etc.  Each  one  of  the 
patients'  sections  is  supplied  with  the 
necessary  utensils  and  equipment;  each 
has  an  examining  room,  so  arranged 
with  curtains  that  it  can  be  changed  into 


OF  THE  TWENTIETH   CENTURY 


123 


124 


THE  AMERICAN  HOSPITAL 


FIG. 


17S.      PSYCHIATRISCH-NEUROLOGISCHE 
KLINIK.    CORNER  OF   WARD. 


a  dark  room ;  also  a  linen  room,  store 
room,  sink  room,  tea  kitchen,  bath  rooms, 
day  room,  and  airing  balcony. 

The  bath  rooms  are  centrally  located 
and  can  be  reached  readily  from  the 
wards  or  single  rooms.  For  the  con- 
venience of  the  wards,  a  corner  water- 
closet  is  provided,  so  screened  as  not  to 
be  objectionable,  at  the  same  time  keep- 
ing the  patients  under  the  surveillance  of 
the   attendant. 


FIG.    176.      PSYCHIATRISCH-NEUROLOGISCHE 
KLINIK.    DAY   ROOM. 


OF  THE  TWENTIETH   CENTURY 


125 


126 


THE  AMERICAN  HOSPITAL 


There  are  no  large  wards  in  any  sec- 
tion, six  beds  at  most. 

In  the  neurological  section,  where  less 
surveillance  is  needed,  the  rooms  are  sep- 
arated by  single  doors ;  while  in  the 
psychiatric  sections  the  wards  are  divided 
by  large  sliding  doors,  making  it  easier 
for  the  night  watch. 

In  the  psychiatric  sections,  three  baths 
to  every  thirteen  beds  are  provided.  The 
control  for  these  baths  is  behind  locked 
cabinet  doors,  and  if  the  temperature  of 
the  water  varies  beyond  certain  limits  an 
electric  alarm  summons  an  attendant. 

In  each  psychiatric  section  is  provided 
an  isolation  room  wath  rounded  corners, 
fastened-down  toilet,  protected  lights, 
and  protected  double  doors  with  an  ob- 
servation window.  The  windows  are 
made  of  swinging  sash,  divided  by  heavy 
reinforced  sash  and  glazed  with  heavy 
plate  glass.  The  floors  are  covered  with 
linoleum. 

The  administration  offices,  the  labora- 
tories, and  the  sleeping  cjuarters  for  the 
attendants  are  on  the  second  and  third 
stories. 

A    large    photographic    gallery    is    ar- 


ranged for  cinematography,  and  has 
special  lights  arranged  for  night  photog- 
raphy. 

These  two  examples  will  show  some- 
thing of  the  development  of  the  psycho- 
pathic hospital  in  Europe ;  but  there 
every  large  hospital  has  its  own  psycho- 
pathic department,  large  or  small,  as  the 
needs  and  development  dictate. 

In  this  country  the  Massachusetts 
Psychopathic  Hospital,  in  Boston,  was 
one  of  the  first  clinics  of  the  kind. 

In  1911  the  State  of  Massachusetts  ap- 
propriated the  sum  of  six  hundred 
thousand  dollars,  to  be  expended  in  the 
building  of  a  new  psychopathic  hospital 
in  the  City  of  Boston.  The  site  selected 
was  in  what  has  come  to  be  known  as 
the  "hospital  district"  of  Boston,  located 
in  close  proximity  to  the  Harvard  Medi- 
cal School,  the  Peter  Bent  Brigham  Hos- 
pital, the  Infants',  the  Children's,  the 
Good  Samaritan,  the  New  England 
Deaconess,  the  Robert  Brigham,  the 
Channing,  the  Huntington  and  other 
hospitals. 

The  work  was  intrusted  lo  Henry  H. 
Kendall,  architect,  under  the  direction  of 


FIG.    178. 


BASEMENT    PLAN-PSYCHOPATHIC    HOSPITAL,    BOSTON. 
Kendall,   Taylor   &  Co.,   Architects. 


OF   THE   TWENTIETH   CENTURY 


127 


SECOND      FLOOR.    PLAN 

FIG.    183. 


F  I  R.^  T        F  1,0  O  R-      PLAN 
FIG.  179. 


rSYCHOPATHIC    HOSPITAL,    BOSTOX. 
Kendall,  Taylor  &  Co.,  Architects. 


128 


THE  AMERICAN  HOSPITAL 


FOUR_TH      FLOOR^     PLAN 

FIG.   182. 


THtR-D      FLOOR-     PLAN* 
FIG.  181. 


PSYCHOPATHIC   HOSPITAL,    BOSTON. 
Kendall,  Taylor  &  Co.,  Architects. 


OF  THE  TWENTIETH   CENTURY 


129 


Dr.  Owen  Copp,  executive  officer  of  the 
State  Board  of  Insanity. 

The  development  of  this  institution  in 
Massachusetts  has  given  the  State  a  mag- 
nificent psychopathic  building  which 
forms  the  clearing-house,  as  it  were,  for 
the  larger  insane  institutions  throughout 
the  state. 

The  building  is  E-shaped,  a  plan  giv- 
ing the  greatest  number  of  rooms  ex- 
posed to  the  best  light  and  air.  It  is  four 
stories  in  height  and  will  accommodate 
one  hundred  and  ten  patients.  The  pa- 
tients are  generally  admitted  at  the  am- 
bulance entrance  on  the  first  floor,  lead- 
ing from  the  side  street. 

On  the  first  floor  (Fig.  179)  there  are 
two  admitting  units,  one  for  each  sex, 
divided  by  a  general  corridor.  These 
units  consist  of  two  admitting  wards  of 
five  beds  each,  general  treatment  rooms, 
baths,  isolation  rooms,  etc.  Connected 
with  this  section  are  the  operating  and 
emergency  department  and  the  offices  for 
the  admitting  officers.  The  remainder  of 
the  first  floor  is  occupied  by  offices  and 
quarters  of  administration,  matron,  and 
staff,  and  the  general  receiving  depart- 
ment, containing  waiting-room,  examin- 
ing rooms,  rooms  for  social  service 
workers,  etc. 

What  might  be  termed  the  patients' 
building  is  separated  from  the  main 
building  by  a  short  connecting  corridor 
containing  the  elevator  and  staircase. 
The  wards  for  the  men  are  placed  on  the 
second  floor  and  those  for  the  women  on 
the  third  floor  (Fig.  181).  Each  has  a 
section  for  disturbed  cases,  divided 
into  separate  rooms  for  each  patient. 

As  in  the  foreign  hospitals  previously 
described,  the  continuous  bath  is  used 
largely  in  the  treatments. 


Each  ward  unit  has  its  own  serving 
kitchen,  and  bath  and  toilet  unit. 

A  large  out-door  day-room  on  the  roof 
(Fig.  182)  affords  opportunity  for  exer- 
cise and  recreation,  and  as  this  institution 
overlooks  the  splendid  park  system  of 
the  city  the  patients  have  much  outside 
of  themselves  to  occupy  their  minds. 

The  Phipps  Clinic,  a  well-studied 
psychopathic  department  of  the  Johns 
Hopkins  Hospital,  shows  much  care  and 
thought,  not  only  in  the  planning  but  in 
the  aesthetic  side  of  hospital  architecture. 
The  restricted  area  made  it  recessary  for 
the  architect  to  carry  the  building  five 
stories  above  the  basement  in  order  to 
provide  for  the  needs  of  the  department. 
For  description,  the  writer  is  indebted  to 
Adolph  Meyer,  M.  D.* 

There  is  an  out-patients'  department, 
with  waiting  room,  which  also  is  used  in 
part  for  occupation  classes,  social  work- 
ers, and  examining  rooms. 

In  the  hospital  division  there  is  an  ad- 
mission ward,  with  provision  for  excited 
cases,  as  well  as  a  semi-quiet  ward,  a 
quiet  ward,  and  a  private  quiet  ward.  A 
number  of  well-arranged,  exclusively 
private  suites  and  rooms  are  provided. 

The  administrative  portion  is  princi- 
pally on  the  north,  consisting  of  offices 
for  administration,  laboratory  and  staff' 
quarters. 

The  medical  treatment  department 
consists  of  hydrotherapy  and  mechano- 
therapy. 

The  top  floor  is  reserved  for  the  large 
recreation  hall  and  roof  gardens,  charm- 
ingly designed  and  colored. 

The  ward  unit  consists  of  an  eight-bed 
ward. 


"The  Modern  Hospital,"  Vol.  I,  No.  2. 


130 


THE  AAIERICAN  HOSPITAL 


CHAPTER  X. 


^nhtvtnlo^i^  department 


The  care  of  patients  afflicted  with  pul- 
monary tuberculosis  demands  special 
study  for  the  problem  is  totally  dift'erent, 
from  almost  every  point  of  view,  from 
that  of  the  treatment  of  the  general  pa- 
tient, whether  surgical,  medical,  or  con- 
tagious, in  the  number  of  gradations  of 
patients  and  the  different  care  required 
for  each  grade. 

If  we  are  to  plan  for  the  care  of  tuber- 
culosis patients  on  the  grounds  of  the 
general  hospital,  then  a  portion  of  the 
site  should  be  selected  remote  from  the 
other  patients'  buildings,  but  with  equal 
regard  to  sunlight  and  protection  from 
the  cold  winds.  If,  as  is  more  likely  to 
be  the  case,  the  tuberculosis  hospital  or 
sanatorium  is  to  be  isolated  and  an  in- 
stitution by  itself,  and  a  site  is  selected 
remote  from  water,  sewerage,  and  other 
municipal  service,  then  the  problems  are 
increased  many  fold,  and  the  natural 
contour,  the  nature  of  the  land,  and  the 
meteorological  conditions  must  be  care- 
fully studied. 

If  planning  for  "all  comers,"  it  will  be 
necessary  to  plan  on  about  fifty  per  cent 
of  the  patients  being  of  the  ambulatory 
class,  who  are  able  to  be  up  and  about 
and  to  do  light  work.  Plans  must  be 
made  for  ground  room  for  exercise  and 
recreation,  buildings  for  light  industrial 
work,  buildings  for  dining  and  enter- 
tainment rooms,  facilities  in  other  wards 
for  carrying  on  the  various  activities  of 
life  under  hygienic  and  supervised  con- 
ditions, the  main  aim  being  to  have  the 
maximum  amount  of  sunshine,  fresh  air, 
and  absolute  ventilation. 

The  area  of  land  must  not  be  restricted 
and  it  should  have  level  stretches  about 
the  buildings.  The  outlook  and  general 
environment  are  almost  as  important  as 
sunlight  and  ventilation — e.g.,  an  other- 
wise beautiful  site  might  lose  much  of 
the  therapeutic  value  if  a  cemetery  were 
in  the  immediate   foreground,  or  if   sit- 


uated  near  noisy  manufacturing  plants 
or   of   smoking  chimneys. 

The  average  incipient  patient  soon 
wearies  of  his  enforced  confinement ;  and 
unless  the  natural  attractions  are  consid- 
ered he  becomes  discontented  and  leaves, 
so  that  the  sanatorium  may  be  wdthout 
patients. 

In  providing  service  for  tuberculosis 
cases  they  may  be  roughly  divided  into 
three  general  groups : 

1st — Those  in  the  last  stages,  in 
many  instances  dying  patients  ; 

2nd — The  ambulatory  cases,  with  in- 
cipient or  even  moderately  advanced 
cases,  incapable  of  regular  work  yet 
enjoying  a  reasonable  degree  of 
health ; 

3rd — The     out-patient     who,     while 

needing    treatment    through    the    day, 

may  return  to  his  home  at  night  under 

proper  supervision. 

For   the  treatment   of   the   first  class, 

wards  or  private  rooms  not  unlike  other 

medical  wards   or  private  rooms  should 

be  provided. 

Proper  care  must  be  exercised  for  the 
protection  of  the  nurse  and  the  preven- 
tion of  the  spread  of  disease. 

For  the  comfort  of  the  patients  the 
wards  should  not  be  too  large ;  if  sub- 
divided by  permanent  screens  they  may 
become  less  depressing.  Everything 
possible  should  be  done  to  brighten  the 
ward,  and  there  should  be  provided  a 
wealth  of  sunshine  and  plenty  of  out-of- 
door  balconies. 

As  the  death  rate  in  these  wards  wall 
naturally  be  greater  than  in  any  other 
part  of  the  institution,  the  method  of  re- 
moving the  body  from  the  building  so  as 
to  attract  the  least  attention  should  be 
studied.  If  the  morgue  can  be  at  some 
little  distance  from  the  wards,  with  an 
underground  connection,  much  mental 
suft'ering  will  be  avoided. 

For  the  ambulatory  case    the  problem 


OF  THE  TWEIs^TIETH   CENTURY 


131 


is  very  different.  Here  there  are  patients 
with  the  disease  in  an  incipient  or  mildly 
advanced  stage,  who  are  up  and  dressed, 
and  active  to  a  certain  degree,  but  for 
whom  there  must  be  provided  proper 
sleeping  quarters,  with  due  regard  to  the 
out-of-door  treatment  recommended  for 
this  class.  There  must  also  be  dress- 
ing and  bath  rooms  which  can  be 
warmed  in  cold  weather,  recreation 
rooms  for  stormy  w^eather,  recreation 
parks  for  pleasant  weather,  and  light  em- 
ployment for  certain  hours.  Every  am- 
iDulatory  patient  should  have  a  cupboard, 
locker,  or  closet,  which  will  be  large 
enough  to  be  entered  and  to  contain  his 
personal  belongings.  This  cupboard 
should  be  well  lighted,  well  ventilated, 
and  well  heated ;  for  to  the  lonely  man 
away  from  family  and  friends  this  may 
be  the  only  place  which  he  may  call  bis 
very  own.  Such  a  cupboard  should  not 
be  less  than  three  by  four  feet  in  size, 
and  should  contain  a  seat,  shelves,  mir- 
ror, and  any  other  conveniences  W'hich 
experience  may  dictate. 

The  toilets  should  be  of  sufficient  size 
to  accommodate  the  patients  of  the  par- 
ticular unit  which  they  serve,  and  should 
be  reasonably  near  the  sleeping  quarters 

The  general  room  or  day  room  should 
be  light  and  cheerful,  as  it  is  the  living- 
room  of  the  family  or  the  unit  which  it 
serves. 

The  sleeping  quarters  can  be  in  wards, 
with  beds  on  either  side,  with  plenty  of 
windows  to  open,  or  of  the  "tent"  or 
"shack"  form,  open  toward  the  south, 
with  beds  to  the  north.  The  modifica- 
tion of  the  shack  has  become  perhaps  the 
most  popular  form  for  the  housing  of  in- 
cipients,  for  with  this  type  the  bed  of  the 
patient  can  be  brought  practically  into 
the  open  when  desired.  The  south  can 
be  closed  with  swinging  sash  or  cloth 
screens,  or  can  be  left  entirely  open. 

Nearly  every  tuberculosis  hospital  or 
sanatorium  has  its  out-patient  clinic, 
where  the  patient  spends  the  day  on  the 
sunny  lawn  or  broad  terraces,  receiving 
nourishing  food  and  good  advice  for 
home  living.  For  this  work  the  principal 
equipment  is  steamer  chairs,  blankets, 
serving  kitchens,  and  intelligent  attend- 
ants.    This     educational     and     helpful 


work,  followed  up  as  it  is  by  the  social 
service  work  of  the  institutions,  is  accom- 
plishing important  results  in  the  stamp- 
ing out  of  the  great  white  plague. 

In  the  large  city  and  county  institu- 
tions the  industrial  work  of  the  institu- 
tion can  be  done  largely  by  the  patients, 
with  a  tailor  shop  for  the  mending  of 
patients'  clothing,  a  harness  shop  for  all 
leather  work,  carpenter  shop  for  the 
necessary  repairing,  sewing  rooms  for  re- 
pairing the  linen  and  the  making  up  of 
new  material.  Light  employment  during 
certain  hours  can  be  made  a  profit  to  the 
institution  and  a  help  to  the  patient. 
U'aiting  on  tables  and  the  light  janitor 


FIG.     190.     REVOLVING    AIRING     BALCONY, 
AMSTERDAM  HOSPITAL. 

work  about  the  building  can  all  be  done 
by  the  patients. 

For  the  ambulatory  class,  dining- 
rooms  must  be  provided,  general  assem- 
bly rooms  for  religious  and  secular 
services,  recreation  rooms,  reading 
rooms,  store  and  post-office,  as  well  as 
general  examining  rooms,  dental  rooms, 
barber  shops,  etc. 

An  operating  department  s-hould  be 
provided,  for  the  presence  of  tubercular 
germs  does  not  prevent  appendicitis  or 
other  troubles. 

One  item  peculiar  to  the  care  of  tuber- 
culosis is  the  provision  for  the  destruc- 
tion of  sputum  cups,  gauze  and  dressings 
which  have  come  in  contact  with  the 
patient.  This  can  be  a  separate  build- 
ing where  the  patient  can  deliver  his 
sputum  cup  and  receive  a  fresh  one.  and 
where  there  is  a  suitable  incinerator  for 


132 


THE  AMERICAN  HOSPITAL 


;     I        :     ;        1     ;        i     j        :      i        i 


/ix      Bed     Waed  9oe,  Men 


Open       -Pocch 


/ix      bto     Waud  Poe,  Women 


Open       Poe,ch 


r  IIZ^T      FLOOE. 


FIG.    191.     CITY   OF   JACKSONVILLE    PROPOSED    TUBERCULOSIS   UNIT. 


the  absolute  destruction  of  all  waste  ma- 
terial. 

Open  air  day  shacks  or  shelters  can  be 
provided  through  the  grounds  at  little 
extra  expense.  There  are  numerous  pat- 
terns and  they  may  even  be  made  revolv- 
ing, like  the  one  photographed  by  the 
writer  in  Amsterdam  (Fig.  190),  where 
the  pavilion  could  be  moved  to  shield  the 
patient  from  sun  or  wind. 

Of  the  many  good  examples  of  tuber- 
culosis hospitals  and  sanatoriums,  few 
will  be  here  shown,  as  this  subject  has 
been  so  carefully  taken  up  by  Dr. 
Thomas  S.  Carrington  in  his  work  on 
"Tuberculosis  Hospital  and  Sanatorium 
Construction,"*  to  whom  the  writer  is 
indebted  for  many  helpful  suggestions  in 
his  own  practice. 

A  simple  solution  of  the  tuberculosis 
ward  for  the  general  hospital  wiiich  was 
designed  for  the  Health  Board  of  the  City 
of  Jacksonville,  is  here  shown  (Figs.  191, 
192).     This  unit  provides  for  a  limited 

*Published  by  National  Association  for  the  Study 
and  Prevention  of  Tuberculosis,  105  E.  22nd  St.,  New 
York. 


number  of  both  chronic  and  incipient 
cases,  the  administration,  food,  and  laun- 
dry being  taken  care  of  in  another  build- 
ing. This  unit  is  a  part  of  the  con- 
tagious department  under  the  charge  of 
the  city. 

The  City  of  New  York,  through  its 
Department  of  Health,  has  established  at 
Otisville,  at  an  altitude  of  from  eleven 
hundred  to  twelve  hundred  feet  in  the 
Shawangunk  Mountains,  a  most  complete 
sanatorium  for  the  care  of  tuberculosis. 

Various  types  of  construction  and  units 
were  built  from  a  single  bed  tent  house 
to  the  more  pretentious  fireproof  build- 
ing; but  in  practically  every  building  the 
sleeping  is  out-of-doors.  Dressing-rooms 
and  day-room  are  provided,  which  are 
heated  certain  hours  in  the  day. 

The  Department  of  Charities  also  pro- 
vides in  its  hospital  work  for  the  care  of 
tuberculosis,  both  in  the  general  hospitals 
on  Blackwells  Island  and  in  the  Sea  View 
Hospital  on  Staten  Island.  In  the  latter 
institution  (Fig.  193)  which,  with  the  ad- 
ditions now  being  built,  will  provide  for 
two  thousand  patients,  the  earlier  group 


OF  THE  TWENTIETH  CENTURY 


133 


^cco/sD    Puool^. 


FIG.    192.     CITY    OF    JACKSONVILLE    PROPOSED    TUBERCULOSIS   UNIT. 


occupied  in  1914  will  be  used  to  house 
the  chronic  or  bed  patients.  The  ambula- 
tory patients  will  occupy  the  twenty-one 
new  pavilions.  The  institution  will  then 
be  well  balanced,  accommodating  an 
equal  number  of  bed  and  ambulatory 
cases.  The  new  out-door  pavilions  are 
being  built  in  two  groups,  the  one  at  the 
southwest  to  accommodate  six  hundred 
men,  with  ''group"  or  executive  build- 
ing, and  the  other  at  the  northeast  to  ac- 
commodate four  hundred  women.  Din- 
ing facilities  for  the  men  will  be  afforded 
by  the  new  dining  hall  placed  on  the  main 
axis  of  the  original  group,  and  served  by 
the  main  kitchen.  This  building  (Fig. 
194)  also  is  used  for  an  entertainment 
and  assembly  hall  for  patients  of  botli 
sexes.  The  women  will  be  served  in  the 
present  dining  building. 

While  the  administration  of  the  entire 
group  will  be  from  the  main  administra- 
tion building,  the  "group"  building  in  the 
center  of  the  male  section  will  contain  the 
offices  of  the  medical  examiner  and 
matron.  There  are  examining  rooms, 
pharmacy    and    treatment    rooms,    baths 


for  men,  store,  barber  shop,  dental  treat- 
ment room,  recreation  rooms  and  library, 
as  well  as  work  rooms  for  various  indus- 
tries, and  a  linen  room  where  all  linen  for 
the  group  will  be  given  out. 

The  pavilion  buildings,  twenty-one  in 
number,  are  to  be  practically  identical 
(Figs.  198,  199).  They  are  two  stories 
in  height,  of  fireproof  material,  divided 
into  four  sleeping  apartments  of  twelve 
beds  each,  with  each  unit  of  tw^o  beds 
separated  from  the  others  by  a  dividing 
screen  six  feet  high,  but  open  on  end 
and  underneath  to  permit  air  circulation. 
These  are  not  heated  and  are  open  to 
the  south,  with  possible  closing  by  the 
use  of  cloth  screens  on  frames  hinged 
at  the  top. 

For  each  two  wards  a  day  room  is 
provided,  connecting  directly  with  the 
toilet  section,  beyond  which  is  the 
locker  room.  Each  patient  is  provided 
with  a  locker  three  by  four  feet,  with 
short  door  and  screened  ceding,  allow- 
ing free  circulation  of  air  but  prevent- 
ing interference  from  outside. 

Two  of  the  units  used  at  the  Bostop 


134 


THE  AMERICAN  HOSPITAL 


ytA  VI tW  HQ/-PITAL  nXT£N/10N 
/TATEN  I/LAND  -  NEW  YOJl^ 
DEftMiTMENT  <"  -Public   CMAfciiity 

EPWAIO    f    /TiVtHJ       ~        iOy-TON.MAJ/l     A/yOCIATCO 

E.tNWICK..A/flNWALL.i  TuCKtR   -  NtW    YOILA  J    AUCHlTECiy 

-  P0«    New   MW-t  i  f  {.MALE    PAVIUOtU, 

■&S.OVP   BuiLDiNa  e  D1N1N6  Hall- 


fig.   193. 


Consumptives'  Hospital  at  Mattapan  will 
serve  to  illustrate  the  various  units  for 
different  treatment  of  chronic  and  in- 
cipient cases.  The  ward  building  ( Fig. 
161)  here  shown  is  two  stories  in  height. 
Each  unit  is  divided  in  the  center,  and 
the  main  service  rooms  are  placed  be- 
tween the  two  fourteen-bed  wards.  Am- 
ple airing  balcony  space  is  provided,  and 
the  unit  has  proved  easy  of  administra- 
tion. For  the  more  active  patients  the 
one-story  pavilions  (Fig.  162)  are  used. 


This  unit  is  similar  to  those  used  in 
other  State  and  City  hospitals,  and  has 
been  fully  described  and  classified  by 
Dr.  Carrington.*  Larger  locker  space 
is  provided  for  the  patients,  additional 
airing  balcony  for  each  bed,  an  emer- 
gency room,  and  a  room  for  the  nurse, 
as  well  as  a  large  day  room  accessible  to 
each  division.  The  building  is  of  wood, 
in  simple,  picturesque  style. 

*Published  by  National  Association  for  the  Study 
and  Prevention  of  Tuberculosis,  105  E.  22nd  St.,  New 
York. 


OF  THE  TWENTIETH  CENTURY 


135 


oooooo   ooooooo 

oooooo   ooooooo 

o   oooo   ooooooo 


ENLAE-GLMENT  "  JtAVim  Ho/WAL 

^TATEN    l/LANP  ~  NtW     YoiiK 

■  Public  Cnfimit/ 


tNLAKGCMENT  ■'•J'EAYltW  HO/WTAL 
yJATEN    I/LAND  ~  NtW     YotK 

DtPAftTMLNT     "    ^OBLIC    CttAtlTlt/ 

tBW»«0     f-.    /TtVENy"    -     60/TOr,,  A\,j-/-\      ,A//OCI»Tt» 
tB™r,.CK,  »^>iNw.ii.   .   Tuc»»t-Ntvy    Vols/    «ICHIT«CT* 


FIG.  195. 


136 


THE  AMERICAN  HOSPITAL 


ENLARQE/AENT  "  Jtk  VIEW  HO/WTAi 
/TATEN  I/LAND  -NEW  YOJiK 
DtPft.IiTME.NT     "   -PUdLIC   CtlAElTlC/ 

tDWARD  f:  /TtVEN/  —  BOJ"TON .  MR/y"!  A//OCl*TtO 
ILtf^W^C^.  A/PINWALL    t   TuCKEH~NtW    VOEK  J     AB-CHlTCCTy 


FIG.  196. 


GEOUP       i>UILDlN& 


ENLAEQtMtNT  "  ^EA  VIEW  Ho/OTAU 
yjATEN    I/LAND  ~  NEW     YotK 

Dt^'AR.TM.ENT      "    4>U5L1C    CnAtLlTIE/ 

tpwAtD    r.  ./Ttvtr^y  --    Bo/TON,  Ma//\     A^/ocmTtlh 
tl«»n»,  A/nt.w<it   <   Tuc.tt-Ntw    Toja/    AlcniTACT.' 


FIG.  197. 


OF  THE  TWENTIETH  CENTURY 


137 


WoMEtv'  -Pavilion 

fllUT-Pi-001!.-PL«J» 


tNLftE-QtMtNT    ■'■'  yCAVlCW  HO/WTAL 
/TAT£N       INLAND      ~   NEW     YOCK. 


DEPAaTME.NT 


■Public     CHARiTit 

—  SoyTON.M*.//!    Ay/oc.i'.Tf 


FIG.  198. 


MtN/'  -Pavilion 

fllUT-fLOOE-PLftN 


LNLAIiQtA^ENT  ^o  yg^  VIEW  tlO/PITAL 
/TATE.N  INLAND  ~  NEW  YORK. 
DcPAn-TMtNT      "'       Public     CHAuiTit/ 

EDWA2D     T-   ^TEVtN/ -  ~£a/TON,W\-ft//l     A/./OCIATtD 

BtNW.CK.  ftyi>fN««»l.L  t  Tuc^EH-  NEW      YolKj    AntniTEc-t-T 


FIG.  199. 


138 


THE  AMERICAN  HOSPITAL 


LECE/ND        i 

A 

\VM2-DJ   -     ! 

'b 

COE-tlDOIii 

C 

5TOW.  CLOjET 

D 

LININ  CLOSET 

I 

BCy.VL  ROC^ 

F 

5LR.VTSG  RM 

G 

BATH     COOf^   ; 

H 

UTlNilL   E.A\    ' 

1 

to:  LIT    ROOM 

J 

JTMCCAJE      ■ 

K. 

LOCkLER.    RM 

L 

LABORATOW  j 

M 

PIAZZA 

■M 

COREIDOE-  1 

:o 

TU.NNEL 

'  V 

VENT  DUCT5 

FIG.    201.    BOSTON    COXSUMPTT\'ES'    HOSPITAL,    WARD    BUILDIXG. 
Maginnis    &   Walsh,   Architects. 


HMnMnrni 


I 


LH  CEND 
A   ASSEMBLY  liOOM 
B    WAB-D 
C    LOCKER.  R.OOM 
D    TOILET 
E    NUHSE'S    TJ.OOM 
F    EMER.CEMCY  R.OPM 
Q    PIAZZA 


dddHttflMDdti 

5 


FIG.   202.    BOSTON    CONSUMPTR-ES'    HOSPITAL,    COTTAGE    FLOOR    PLAN. 
Maffinnis    &   Walsh,   Architects. 


OF   THE   TWENTIETH   CENTURY 


139 


CHAPTER  XL 

Special  departments! 


Under  this  section  will  be  briefly  men- 
tioned the  following  departments  and  a 
few  examples  given : 

Pathological  and  laboratory  zvork, 

Roentgen-ray   work, 

Out-patient  se)'Z'ice, 

Social  service  zvork. 

The  development  of  the  laboratory 
zi'ork  in  the  general  hospital  de- 
pends largely  on  the  personnel  of  the 
staff,  the  proximity  to  established  inde- 
pendent laboratories,  and  thj  possibility 
of  development  within  the  institution. 
In  the  larger  hospitals,  separate  build- 
ings away  from  the  main  group  are  de- 


voted entirely  to  laboratory  purposes, 
where  there  are  class  rooms  for  teach- 
ing, autopsy  rooms  and  morgue;  and 
often  the  chapel  is  connected  with  this 
building.  These,  with  the  local  labora- 
tories in  the  ward  units  and  the  operat- 
ing units,  form  a  chain  for  diagnostic 
and  research  work. 

In  the  small  hospital,  however,  of  fifty 
beds  or  less,  where  the  laboratory  work 
is  done  by  members  of  the  staff',  it  is  not 
necessary  to  provide  extensively.  Light 
basement  rooms  will  generally  serve  for 
the  purpose,  the  principal  necessity  be- 
ing light. 


4'5    T/imrt  MTT-cJiUTtMe^ 


FIG.  210.    MUXICH-SCHWABING  HOSPITAL.     PATHOLOGICAL   BUILDING.     FIRST   FLOOR  PLAX. 


140 


THE  AMERICAN  HOSPITAL 


2   ^£oe£,  6  Ajj/kuff.  iO   /esezimmer.,    ^   '^^£ecLowff.    - 

W    r    I?,   f    iVf    f   /    1°   f    l~ : f= p^  ilt.-j.ioa. 

FIG.  211.    MUNICH-SCHWABING  HOSPITAL.    PATHOLOGICAL  BUILDING.     SECOND  FLOOR  PLAN 


For  the  larger  research  laboratories, 
space  for  the  hygienic  care  of  animals 
used  in  experimentation  must  be  pro- 
vided, either  on  the  roof  of  the  building 
or  even  in  a  separate  building;  but  if 
they  must  be  kept  on  lower  levels,  the 
rooms  should  receive  special  ventilation. 

Every  hospital,  even  of  fifty  beds  or 
less,  should  have  a  room  where  autopsies 


can  be  performed,  and  suitable  equip- 
ment for  the  same  should  be  furnished. 
This  room  must  be  well  ventilated, 
should  have  a  flushing  floor  drain,  sim- 
ple autopsy  table,  with  sink  and  facili- 
ties for  properly  handling  the  body. 
Good  day  lighting  is  desirable  but  not 
necessary ;  but  there  must  be  an  abun- 
dance of  artificial  light. 


FIG.    212.     MUNICH-SCHWABING   HOSPITAL.     DISSECTING    ROO:\r. 


OF  THE   TWENTIETH   CENTURY 


rm  nm  nm  rrri  nm  fTTT^ 

D  D  n 


Hfii  nrn  nm  rrm  nm  ffTTTi 


a 


D  0   0  D   n  -Q-&- 


£ru/idriss. 


K 4P* 


Crosse  .M^gv. 


l|l      "      'I'  .   I        ^' 


np 


141 


FIG.   213.     MUNICH-SCHWABING   HOSPITAL.      PATHOLOGICAL   DEPARTMENT.     ANIMAL    BLDG. 

Richard    Schachner,   Architect. 


142 


THE  AMERICAN  HOSPITAL 


Pathologisches  Institut,  I.  Stock i. 


Pathologisches  Institut,  ErdgeschoC 


Vo  r  r  a  u  m 


^e.cHe.    ^   ,^„3 

le  1  c  lien 

Eingang 

'Leichen^ 

Trager 

Aufseher 

Tiere 

T,e.e 

1 

Aufbewahrunq 

^r"  [ 

( 

^^ 

^    " 

ffl 

K     o     r     r      I     d     o 


K  a  p  e  1 1  e 


Pathologisches  Institut,  Keller  i. 


FIG.  214.     ST.  GEORG  HOSPITAL. 


In  the  larger  hospitals  in  Europe,  the 
pathological  department  is  under  sep- 
arate management.  The  plans  of  the 
Pathological  Institute  of  the  Munich- 
Schwabing  Hospital  are  here  shown 
(Figs.  210  and  211)  and  are  self-explan- 
atory. The  detail  and  equipm.ent  are  ex- 
cellent, the  dissecting  room  in  particular 
(Fig.  212)   showing  most  careful  atten- 


tion to  plumbing  and  outfit.  In  this  in- 
stitution there  is  a  separate  building 
(Fig.  213)  for  animals,  with  special  op- 
erating room  perfectly  equipped. 

The  pathological  building  at  St.  Georg 
is  another  carefully  developed  depart- 
ment, as  the  few  illustrations  will  show 
(Figs.  214  and  215). 

The  Roentgen-ray,  in  its  divers  uses, 


OF  THE  TWENTIETH   CENTURY 


143 


FIG. 


215.      ST.    GEORG    HOSPITAL. 
TABLE. 


DISSECTION 


plays  a  most  important  part  in  the  work 
of  every  hospital.     Its  use  in  diagnoses 


has  become  invaluable.  While  it  is  true 
that  the  best  results  can  be  obtained  by 
only  the  expert  roentgenologists,  never- 
theless even  the  limited  use  of  the  X-ray 
in  the  small  hospital  is  most  helpful. 

The  advance  in  the  possibilities  of 
uses  to  which  the  Roentgen-ray  can  be 
put  is  so  rapid  that  no  attempt  will  be 
made  to  show  them  now.  We  know, 
however,  that  the  recurrent  use  of  this 
powerful  medium  has  caused  serious 
burns  and  the  destruction  of  live  tissue 
so  that  the  ooerators  should  have  every 
possible  protection.  Lead  screens  afford 
this  protection  against  both  direct  and 
reflected  rays.  It  is  more  common  now 
to  provide  control  rooms  heavily  lined 
with  lead  at  least  one-eighth  inch  thick ; 


FIG.  216.     MAYO  CLINIC,   ROCHESTER,   MINN.     FIRST   FLOOR  PLAN. 
Ellerbe    &   Round,   Architects. 


Room  107~i 
Room  105 

Roo°mJolk°"-'*^*'--«-- 

Room  110 

Room  103  J 

Room  109  C.  H.  Mayo,  Consulta- 
tion. 

Room  111  Reception,  W.  J.  and 
C.    H.    Mayo. 

Room  113  W.  J.  Mayo,  Consulta- 
tion. 

Room  1151 

Room  117  L     „  ,       . 

Room  119  f     Consultation  rooms. 

Room  121 J 


Room  123^ 

Room  125 

Room  127 

Room  132 

Room  134  I    „ 

Room  138  f    Consultation    rooms. 

Room  136 

Room  140 

Room  144 

Room  146 

Room  135     Clinical. 

Room  137     Clinical. 

Room  139     Clinical. 

Room  141     Hospital    assignment. 

Room  164    Alphabetical    index. 

Room  169    Accounts. 


Consultation   rooms. 


Room  148  1 

Room  150 

Room  162 

Room  154 

Room  156 

Room  158 

Room  160 

Room  152 

Room  1741 

Room  172  I   „ 

Room  170  f  Stenographers. 

Room  168  J 

Room  Kl     Mail    distribution. 

Room  175     Dictaphone. 

Room  173    Office. 

Room  177.     Office  telephone  central. 


144 


THE  AMERICAN  HOSPITAL 


and  where  vision  is  required,  lead  glass 
is  used  for  the  operator. 

A  few  precautions  may  be  mentioned 
in  providing   for  this  department : 

In  selecting  Roentgen  laboratory 
avoid  cellar,  particularly  if  it  is  damp : 
moisture  causes  trouble  with  the  trans- 
former and  high  tension  wiring. 

The  room  should  be  sufficiently  high 
studded  to  allow  overhead  high  tension 
system. 

The    X-Ray    transformer    requires    a 
special  electric  current  supply.      Do  not 
rely  on  the  word  of  a  local  electrician  or 
power  company- 
Special  precaution  should  be  taken  that 


all  electric  light  conduits  in  Roentgen 
room  are  properly  grounded. 

Arrangements  should  be  made  for  a 
perfect  ground  near  position  of  X-Ray 
transformer. 

The  room  to  be  used  for  fluoroscopy 
should  be  so  arranged  that  it  can  readily 
be  made  light  proof. 

Special  lead  protection  is  necessary 
where  the  Coolidge  tube  is  used  for 
X-Ray  therapy. 

The  dark  room,  for  developing  and 
loading  plates,  should  be  located  as  near 
the  Roentgen  laboratory  as  possible. 

Hot  water,  as  well  as  cold  running 
water,  in  the  dark  room  is  desirable. 


m  nt33 — mhi  u  iiiu — nmii — ciir       illiii    lttti — aintd,  "'  i'  ii"-  ■  i;  ■'  z-         il 


FIG.  217. 


MAYO  CLINIC.     SECOND  FLOOR  PLAN. 
EUerbe    &   Round,    Architects. 


Room  271     Cystoscopic. 

Room  273     Private  office,  Braasch. 

Room  201     Cystoscopic. 

Room  203     Cystoscopic. 

Room  205    Refraction. 

Room  209    Eye. 

Room  209a  Eye. 

Room  213     Eye. 

Room  215    Nose   and    throat. 

Room  221     Nose   and   throat. 

Room  227  Laboratory,  bacterio- 
logical. 

Room  227a  Laboratory,  parasito- 
logical. 


Room  232     Clinical.  Room 

Room  228    Clinical.  Room 

Room  226     Clinical,       blood       cul-  Room 

tures,    etc.  Room 

Room  224    Clinical.  Room 

Room  222    Clinical.  Room 

Room  220    Clinical.  Room 

Room  259a  X-ray     indexing.  Room 

Room  278    X-ray    viewing.  Room 

Room,  249a  X-ray    storage.  Room 

Room  249     Fluoroscopic.  Room 
Room  249a  Fluoroscopic. 

Room  248     Food    preparation.  Room 
Room248a  Exposure,    X-ray. 


2S0    Exposure,    X-ray. 

252     Exposure,    X-ray. 

254     Exposure,    X-ray. 

258c  Developing. 

258b  Developing. 
264    Exposure. 
268    Exposure. 
270     Exposure. 

274  Exposure. 

275  Private    office. 

J2b    Toilet,     men,     special, 

public. 
J2b    Toilet,  women,  special, 

public. 


OF  THE   TWENTIETH  CENTURY 


145 


This  department  should  be  planned  for 
at  the  beginning,  not  left  to  chance. 

The  writer  knows  of  no  more  exten- 
sive use  for  diagnoses  than  at  the  Mayo 
Clinic  (Figs.  216,  217,  218,  219)  at 
Rochester,  Minn.  Nearly  half  of  the 
second  floor  of  this  large  building  is  de- 
voted to  this  form  of  diagnosing. 

The  space  allotted  to  this  work  in  the 
various  plans  shown  may  be  noticed— - 
Ohio  Valley  General  Hospital  (Figs.  77 
and  220),  Youngstown  Hospital  (Fig. 
74),  Barre  Hospital  (Fig.  239),  etc. 

Today  nearly  every  large  hospital  in 
the  country  has  an  out-patient  and  social 
service  department,  where  more  or  less 
dispensary  work  is  afiforded  people  who 
are  not  enrolled  as  patients  of  the  hos- 
pital, or  more  home  care  is  provided. 

The  problem  of  how  best  to  serve 
this  class  without  lessening  the  service 
to  the  in-patients  is  one  needing  much 
study. 


The  location  of  the  hospital  in  the 
community,  the  likelihood  of  casualties, 
and  the  nearness  to  other  dispensaries 
have  a  bearing  on  the  development  of 
this  department.  Except,  perhaps,  in  the 
large  city  communities,  this  dispensary 
or  out-patient  service  can  be  rendered 
more  effectively  in  connection  with  the 
general  hospital ;  for  the  reason  that 
many  of  the  departments  can  be  used  in 
common,  such  as  the  drug  room,  the 
Roentgen-ray  department,  the  hydro- 
and  nlechano-therapeutic  departments, 
the  heating  plant,  and,  in  emergencies, 
the  service  of  members  of  the  staff  and 
nursing  forces. 

The  size  and  shape  of  this  department 
must  be  governed  by  the  needs  and  the 
available  space.  If  the  call  is  small,  it 
may  be  placed  safely  in  the  basement  of 
one  or  more  of  the  hospital  buildings,  or 
on  certain  floors  set  apart  for  this  pur- 
pose. 


FIG.  218.     MAYO   CLINIC.     THIRD   FLOOR   PLAN. 


Room  377     Editorial. 

Room  303     Editorial. 

Room  F3a  Toilet    staff   men. 

Room  305  Pathological  labora- 
tory. 

Room  309  Pathological  labora- 
tory. 

Room  313     Stenographic. 


Ellerbe    &   Round,   Architects. 

Room  315  Pathological  labora- 
tory. 

Room  323  Pathological  labora- 
tory. 

Room  325  Pathological  labora- 
tory. 

Room  331     Chemical   laboratory. 

Room  363     Reading. 


Room  320  Pathological     labora- 
tory. 

Room  359  Artists'    studio. 

Room  355  Coat   room. 

Room  349  Assembly    room. 

Room  366  Stock  room. 

Room  375  Reading    room. 

Room  369  Reprints. 


146 


THE  AMERICAN  HOSPITAL 


^Mackintosh*  says,  "The  out-patient 
department  should  be  a  one-storied 
building,  quite  apart  from  the  hospital.'" 

AMiether  this  department  be  in  a  sep- 
arate building  of  one  story  or  multi- 
story, or  connected  with  any  other  de- 
partment, there  are  certain  practical 
principles  which  must  be  considered. 
The  waiting-room  should  be  large,  Avell- 
lighted,  and,  above  all.  well  ventilated 
and  centrally  located,  with  the  seating 
space  so  arranged  as  to  give  perfect  cir- 
culation and  prevent  congestion. 

The  entrance  should  be  large  and  well 
protected  from  storms.  As  many  of  the 
out-patients  are  children-in-arms,  ade- 
quate provisions  must  be  made  for  the 
perambulators  and  wheel  chairs,  at  or 
near  the  street  level. 

\\'here  practicable,  the  exit  should  be 


*"Construction,    Equipment    and   Management   of   a 
General  Hospital,"  by  Donald  Mackintosh,  M.B. 


a  separate  door.  Xear  this  door  can  be 
located  the  laboratory  and  the  pharmacy. 

Xear  the  preliminary  examination 
desk  there  should  be  isolation  rooms, 
with  a  separate  exit  for  any  suspicious 
case  or  case  of  communicable  disease. 

The  arrangement  and  division  of  de- 
partments may  depend  on  the  respective 
service. 

The  L-shaped  building  often  affords  a 
better  division  of  departments  than  the 
rectangle,  since  the  large  waiting-room 
can  be  placed  at  the  junction  of  the  two 
wings,  giving  better  supervision  from 
the  administrative  center. 

Xear  the  entrance  should  be  the  office 
of  the  department,  the  examining  rooms, 
and  the  social  sen'ice  workers"  office. 

In  the  small  service,  by  the  use  of  dif- 
ferent rooms  at  different  hours  and  by  a 
slight  change  in  equipment,  the  treat- 
ment of  the  different  diseases  can  be  ac- 


Room  401    Store  room. 

Room.  409-405  Pathological     muse- 
um. 

Room  411     Pathological     store 
room. 

Room  420    Drafting. 


FIG.    219.     MAYO    CLINIC.      ATTIC. 
Ellerbe    &    Round,    Architects. 

Room  413     Pathological      prepara- 
tion. 
Room  422    Shop 
Room  469    X-ray    store    room. 
Room  466    X-ray   machines. 
Room  464    X-ray  dry  plates. 


Room  460     Photographic     store 

room. 
Room  458    Bromide    room. 
Room  453a  Developing. 
Room  468    Waiting   room. 
Room  453     Photographic    gallery. 


OF  THE   TWENTIETH   CENTURY 


147 


FIG.   220-A.    UPRIGHT  FLUOROSCOPE. 


FIG.  222.     CHILDREN'S  HOSPITAL,   PHILADELPHIA.     OUT-PATIENT  DEPARVMENT. 


148 


THE  AMERICAN  HOSPITAL 


complished ;  in  fact,  splendid  work  can 
be  done  in  a  very  small  space.  But  the 
ideal  out-patient  department  should  have 
space  and  divisions  for  general  medical 
clinic,  children's  clinic,  surgical  clinic, 
gynecology  clinic,  genito-urinary  clinic, 
eye-ear-nose-and-throat  clinic,  and  dent- 
al clinic ;  and  as  the  department  grows, 
separate   space   should  be  provided    for 


orthopedic,  nervous  and  mental  diseases, 
and  for  the  treatment  of  tuberculosis, 
whooping  cough,  and  vaginitis. 

Since  the   recent  epidem'c^  of   infan 
tile  paralysis,  separate  departments  have 
been    established    for    the   after-care    of 
such  patients. 

The  work  of  examination  and  treat- 
ment is  facilitated  if  provision  is  made 


FIG.  221.     WESTERN  INFIRMARY.     GLASGOW  OUT-PATIENT  DEPARTMENT. 


FIG.   223.    PROPOSED   OUT-PATIENT   DEPARTMENT    FOR   NEW   YORK   CITY.      FIRST    FLOOR. 

Designed   by   S.    S.    Goldwater,   M.D. 


OF   THE   TWENTIETH   CENTURY 


149 


for  patients  to  wait  at  or  near  the  treat- 
ment rooms.  In  some  cases,  separate 
waiting-rooms  or  history  corridors  are 
provided  where  the  assistants  can  take 
down  the  history  and  prepare  the  patient 
for  examination  or  treatment. 

In  providing  for  the  cHnics,  the  larger 
services  such  as  the  medical  and  chil- 
dren's services  should  be  located  on  the 
entrance  floor,  in  order  to  avoid  conges- 
tion. The  orthopedic,  with  the  plaster 
work  and  brace  shop,  may  well  be  lo- 
cated in  the  basement. 

As  to  the  size  of  the  treatment  rooms, 


there  may  be  a  difference  of  opinion ;  one 
man  may  wish  a  large  room  with,  per- 
haps, cloth  screens  dividing  the  patients , 
another,  a  small  room  opening  from  the 
general  room  of  that  service,  where  any 
conversation  will  not  be  overheard  bv 
the  patients  nearby.  If  the  small  room 
is  used,  the  ventilation  should  be  assured 
and  positive.  If  the  rooms  are  to  be 
used  for  teaching  purposes,  they  should 
be  of  larger  size. 

In  the  surgical  department,  there 
should  be  the  complete  operating  room 
with    its    adjuncts — the    sterilizing    and 


FIG.  224.    OUT-P.\TIEXT  DEPART:MEXT  FOR  NEW  YORK  CITY.     SECOND  FLOOR. 
Designed    by    S.    S.    Goldwater,    M.D. 


FIG. 


OUT-PATIENT    DEPARTMENT    FOR    NEW    YORK    CITY.      THIRD    FLOOR. 
Designed   by    S.    S.    Goldwater,   !M.D. 


150 


THE  AMERICAN  HOSPITAL 


anaesthetic  room;  and  as  many  of  the 
minor  operations  are  performed  under 
anaesthetics.  Recovery  rooms  should 
also  be  provided. 

Each  clinical  division  should  be  made 
a  complete  working  unit,  with  proper 
plumbing  fixtures,  cabinets,  and  supplies 
for  disinfecting  against  contagion,  and 
apparatus  for  sterilization  of  instru- 
ments, etc. 

The  floors,  the  walls,  the  ceilings,  and 
the  furniture  should  be  of  a  material 
readily  scrubbed  and  of  simple  design. 
The  waiting  room,  however,  should  not 
be  void  of  artistic  merit,  for  even  with 
the  out-patient,  the  environment  should 
tend  to  benefit  the  mind  as  the  treatment 
does  the  body. 

While  the  social  service  work  in  con- 
nection with  hospitals  and  out-patient 
departments  is  a  development  of  recent 
vears.  nevertheless  it  has  become  a  most 
important  and  necessary  adjunct.  It  is 
truly  a  twentieth-century  development, 
starting  in  Boston  in  1905  through  Dr. 
Richard  Cabot,  who  introduced  the  so- 
cial worker  as  a  means  of  securing  more 
accurate  diagnosis  and  rendering  more 
effective  treatment. 

The  social  worker  co-operates  with  the 
clinician.  Together  they  take  the  his- 
tory, one  examines  the  patient,  the  other 
"investigates  the  social  cause  of  the 
ailment."  The  physician  prescribes ;  the 
social  worker  "follows  up"  the  homelife, 
sees  that  the  instructions  of  the  phy- 
sician are  carried  out,  and  encourages 
better  home  environment.  It  is  obvious 
that  if  the  instructions  of  the  medical 
man  in  the  clinic  are  not  carried  out,  the 
time  is  wasted  and  the  patient  returns 
without  benefit.  The  social  service 
worker  renders  here  invaluable  service 
to  the  hospital,  to  the  dispensary,  and  to 
the  public. 

The  subject  of  the  out-patient  and  so- 
cial service  departments  has  been  so  ably 
covered  by  Mr.  Michael  M.  Davis,  Jr.,* 
Dr.  Andrew  R.  Warner,  and  Miss  Ida 
yi.  Cannony  that  it  would  be  presumptu- 
ous in  the  writer  to  enlarge  more  on  the 
subject. 

*"Dispensaries — Their  Organization  and  Manage- 
ment"  (in  press). 

f'Social  Work  in  Hospitals,  Russell  Sage  Founda- 
tion." 


A  few  illustrations,  however,  may 
serve  to  show  the  planning  of  a  few  de- 
partments of  this  kind. 

A  more  complete  out-patient  depart- 
ment is  hardly  to  be  found  than  that  of 
the  Western  Infinnary  at  Glasgow 
(Fig.  221).  From  the  time  the  patient 
enters  until  he  leaves,  it  is  not  necessary 
for  him  to  cross  his  own  path.  He  final- 
ly comes  up  in  front  of  the  dispensary 
and  goes  thence  to  the  exit. 

At  the  entrance  is  the  preliminary 
waiting-room  for  new  patients,  with  its 
isolation  and  diagnosis  room;  then  the 
large  central  Avaiting;  the  -special  treat- 
ment room  for  eye,  ear,  nose,  and  throat ; 
for  minor  dressings ;  and  the  various 
surgical  and  medical  clinic  rooms,  with 
dressing-rooms  connected ;  each  unit  a 
teaching  theatre,  with  circular  benches 
for  students,  with  the  dispensary  near 
the  exit. 

A  special  students'  entrance  is  pro- 
vided, with  corridor  above  and  exit  pas- 
sage, connecting  with  each  o^  the  clinic 
rooms. 

The  first  building  of  the  Children's 
Hospital,  Philadelphia,  to  be  built  is  that 
for  out-patients.  Entrance  is  through  a 
large  vestibule  arranged  for  the  storage 
of  baby  carriages.  A  record  office  fills  a 
commanding  position.  The  babies'  dis- 
pensary, with  examining  rooms  and  a 
milk  and  duty  room  adjoining,  occupies 
the  central  position  in  the  rear  of  the 
record  desk.  The  medical  and  surgical 
examining  rooms  use  the  rest  of  the 
first  floor  (Fig.  222). 

The  plans  show  in  the  basement  the 
detention  room  for  suspected  cases,  a 
Avhooping-cough  clinic  having  a  separ- 
ate entrance.  The  X-ray,  orthopedic, 
and  plaster  rooms  are  on  this  floor.  The 
eye,  ear,  nose,  and  throat  treatment  and 
utility  rooms  are  on  the  second  floor : 
also  the  operating  and  recovery  rooms. 
The  third  floor  is  occupied  by  the  labora- 
tories. 

The  plan  of  an  ideal  out-patient  de- 
partment suggested  by  Dr.  S.  S.  Gold- 
water  in  Mr.  Henry  C.  \\'right's*  report 
on  City  Departments  of  Xew  York, 
shows  the  working  out  of  a  three-storv 


*Report    of    Committee    on    Inquiry    into    Hospitals 
and  City  Homes   of  New  York  City. 


OF  THE  TWENTIETH   CENTURY 


151 


152 


THE  AMERICAN  HOSPITAL 


out-patient  department  on  a  restricted 
city  site  with  buildings  adjacent.  The 
plans  (Figs.  223,  224,  225)  show  the 
possibilities  of  such  a  site  and  the  plac- 
ing of  the  rooms  and  corridors  to  con- 
serve light,  assure  circulation,  and  afford 
ease  in  the  handling  of  patients. 

The  small  out-patient  department 
(Fig.  226)  of  the  Macon  Hospital, 
where  the  problem  of  serving  the  col- 
ored as  well  as  the  white  must  be  met, 
shows  the  possibilities  of  even  a  small 
unit. 

The  waiting-rooms  for  both  white  and 
colored   are   supervised   from   one   desk. 


The  treatment  rooms,  however,  are  not 
divided.  A  complete  operating  depart- 
ment is  here  provided,  which  will  serve, 
to  a  certain  extent,  for  minor  operations 
for  the  colored  patient,  the  wards  for 
whom  are  on  the  second  and  third  stories 
of  this  building. 

The  dispensary  building  for  the  East 
Nezt<  York  Hospital,  for  the  time  being, 
will  serve  for  dispensary  and  hospital. 
As  shown  by  Figs.  227  and  228,  a  por- 
tion of  the  ground  floor  and  all  of  the 
second  will  be  used  for  out-patient  ser- 
vice. Worked  out  on  the  "L"  plan,  with 
the  waiting-room  at  the  junction  of  the 


OF  THE  TWENTIETH   CENTURY 


153 


two  wings  and  with  the  administration 
and  examining  rooms,  the  social  service 
office,  the  pharmacy,  and  the  laboratory 
in  central  locations,  the  problem  of  car- 
ing for  the  patients  should  be  simple. 
The  X-ray  and  hydro  departments  are 
on  the  ground  floor. 

While  the  in-patient  work  of  the  Hos- 
pital for  Sick  Children,  at  Toronto  (Fig. 
229) ,  and  the  work  at  the  Lakeside  Home 
is  tremendous,  the  out-patient  work 
and  the  milk  dispensary  work  are  even 
greater.      The    entire    ground    and    first 


floors  of  the  new  contagious  wing  and 
a  large  portion  of  the  first  floor  of  the 
old  building  are  used  for  the  out-patient 
work.  The  main  waiting-room  connects 
at  the  left  with  the  pharmacy ;  the  labor- 
atories at  the  rear  with  the  hospital  and 
pasteurizing  plant  and  at  the  right  with 
the  various  departments  including  med- 
ical, surgical,  eye,  ear  and  throat,  ortho- 
pedic, etc.,  while  in  the  basement  is  a 
large  measles  clinic,  and  the  brace  and 
mechanical  shops  for  making  of  appar- 
atus. 


154 


THE  AMERICAN  HOSPITAL 


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OF   THE   TWENTIETH   CENTURY 


155 


CHAPTER  XII. 


^f)e  Entail  ?|ospital 


The  development  of  the  small  hospital 
is  largely  American.  While  the  village 
or  small  hospital  may  have  started  in 
England,  as  stated  by  Taylor,*  the  greater 
development  has  been  in  this  country. 
One  can  find  hundreds  of  well-planned 
hospitals  of  fifty  to  one  hundred  beds ; 
but  for  the  smaller  private  hospitals,  one 
is  more  likely  to  find  the  adaptation  of 
some  dwelling,  doing  good  service  but 
handicapped  at  every  turn  for  lack  of 
conveniences  for  economical  and  efficient 
work. 

Every  hospital  must  have  its  begin- 
ning; few  indeed  can  start  with  a  com- 
plete equipment ;  so  the  remodelled 
house  should  be  looked  upon  as  the  step- 
ping stone  to  something  more  complete. 

It  generally  happens  that  before  the 
house  has  been  fitted  for  hospital  pur- 
poses, enough  money  is  expended  to  go 
far  toward  building  a  suitable,  up-to-date 
institution.  Even  then  there  will  be 
waste  and  unavailable  room,  which  must 
be  heated  and  taken  care  of.  The  finish 
which  is  attractive  and  necessary  for  a 
residence  becomes  almost  a  menace  in  a 
hospital.  The  staircases  and  halls  are 
generally  narrow,  the  rooms  are  not 
properly  ventilated,  the  toilets  are  badly 
arranged,  and  the  floor  materials  are  not 
suitable.  In  other  words,  an  undue 
amount  of  energy  must  be  expended  in 
the  housekeeping  for  such  a  building, 
and  this  will  detract,  in  all  probability, 
from  the  care  of  the  patient. 
_  The  same  standards  of  number  and 
size  of  utilities  are  not  apphcable  to  a 
fifteen-bed  that  would  be  suitable  for  a 
fifty-bed_  establishment,  for  it  would  be 
all  utilities,   with  no  room  for  patients. 

In  the  small  hospital  there  is  not  the 
need  for  the  separation  and  segregation 
of  utilities ;  one  room  may  serve  for 
toilet,  sink  and  bath ;  food  rnay  be  taken 
directly  from  the  kitchen  to  the  patient; 

•Brickbuilder,  January,  1904. 


the  operating  room  may  serve  for  both 
surgical  and  maternity  work. 

Even  in  the  small  hospital  the  life  of 
the  patients  should  be  safeguarded;  and 
the  construction,  the  egress,  the  careful 
consideration  of  the  patient  are  just  as 
important  as  in  a  large  plant.  Fireproof 
construction  may  not  be  absolutely  nec- 
essary but  is  always  desirable,  and  is 
generally   an   economy   in   the   end. 

It  is  possible,  however,  to  meet  mod- 
ern requirements  in  the  small  village 
hospital  and  at  moderate  expense,  and  the 
examples  following  will  show  the  solu- 
tion here  of  several  problems.  However 
small,  each  institution  must  be  balanced 
for  its  special  location  and  purpose. 

In  Dr.  IVilliauis'  Private  Sanatorinin, 
Macon,  Ga.  (Figs.  236  and  237 j,  the 
problem  was  to  provide  for  the  care 
of  both  medical  and  surgical  cases,  for 
offices,  and  for  an  out-patient  department 
for  colored  people. 

The  contour  of  the  land  gave  the 
advantage  of  being  able  to  place  kitchen, 
dining-room,  and  store  rooms  in  the  base- 
ment and  still  get  proper  light. 

The  first  floor  is  occupied  by  offices,  re- 
ception room,  out-patients'  clinic,  ambu- 
lance entrance,  and  rooms,  service  and 
airing  balcony  for  six  patients.  The  am- 
bulance entrance  room  and  clinic  oppo- 
site are  made  sufficiently  large  so  that 
minor  dressings  may  be  done  here,  or 
even  a  slight  operation  in  a  septic  case 
which  one  would  not  wish  to  take  to  the 
main  operating  room.  The  elevator  and 
stairway  to  the  second  floor  are  near 
this  entrance. 

Though  sm'all,  the  operating  depart- 
ment on  the  second  floor  is  complete. 
There  is  the  operating  room,  surgeons' 
scrub-up  room,  anaesthetizing  room,  and 
sterilizing  room,  with  complete  equip- 
ment. This  department  is  in  a  wing  on 
the  north  side  of  the  building  and  is  en- 
tirely shut  oft'  from  the  rest  of  the  hos- 
pital. 


156 


THE  AMERICAN  HOSPITAL 


PLAN   OF  FIRST    FLOOR.' 


FIG.   236.    WILLIAMS'   PRIVATE  SANATORIUM,  MACON,   GA. 
Edward    F.    Stevens,    Architect. 


OF  THE  TWENTIETH   CENTURY 


157 


,n-a  m 


m. 


-■mm  Mw 


^W9    =1 


A)R1N6       BALCONY 


CORRIDOR..  L      PRIVATE.  l2o«n 


ANAE/THETIC 
STERILIZING     R'M.         ■    /         *^*"'"- 


/^ 


OPERATING   rH,        \ 


PRIVATE   Ro»M 


PRIVATE  RoTI. 


PRIVATE   Room. 


CORRIDOR  M^^    PRIVATE   Ro»M. 


r!vq%^wv^ 


^- 


'^  DOCTOR/ Vn, 


PRIVATE  R'M 


PRIVATE  R'M. 


•PLAN  OF- SECOND-  rUOOR- 


PIJIVATE  RM, 


3  BED  WAR.D. 


FIG.    237.    WILLIAMS'    PRIVATE    SANATORIL^M,    MACON,    GA. 


158 


THE  AMERICAN  HOSPITAL 


FIG.    238.     DEACONESS   HOSPITAL,    CONCORD,    MASS. 
Edward    F.    Stevens,   Architect. 


OF   THE   TWENTIETH   CENTURY 


159 


On  the  main  floor  with  the  operating 
room  are  eight  private  rooms  and  a  three- 
bed  ward;  also  the  necessary  utihty 
rooms.  All  rooms  occupied  by  patients 
are  located  on  the  south  and  west.  An 
airing  balcony  of  sufficient  size  to  ac- 
commodate all  patients  is  placed  on  each 
story,  on  the  southeast  side  of  the  build- 
ing. 

The  nurses  are  accommodated  in  a 
separate  building  nearby. 

This  is  a  complete  hospital  of  seven- 
teen beds,  which  cost  less  than  twenty- 
five  thousand  dollars,  Avith  all  modern 
details,  ready  for  furnishing. 

A  unique  problem  presented  itself  in 
planning  the  little  hospital  for  the  Nezv 
England  Deaconess  Association,  in  Con- 
cord, Mass.  (Fig.  238).  Only  ten  or 
twelve  beds  were  wanted,  hut  sufficient 
accommodation  was  demanded  of  the 
kitchen  for  summer  tent  work,  and  an 
additional  private  ward  which  was  added 
two  years   later. 

The  site  is  almost  ideal,  being  on  a 
slight  eminence,  with  a  level  plateau 
stretching  to  the  south,  pine  trees  at  the 
back,  and  an  extended  view  of  river  and 
hills. 

The  first  floor  of  the  original  or  north 
building  constituted  the  hospital.  The 
front  is  north,  and,  therefore,   is  taken 


up  with  the  combination  reception  room 
and  office,  and  wdth  the  utilities.  In  the 
eastern  extension,  shut  off  from  the  main 
hospital,  is  the  operating  suite,  consist- 
ing of  operating  room,  sterilizing  room, 
anaesthetizing  room,  and  surgeons' 
scrub-up  room.  The  south  and  west 
sides  are  devoted  to  the  rooms  of  pa- 
tients. An  airing  balcony  extends  the 
entire  width  of  the  south  front,  and  ev- 
ery ward  and  private  room  opens  direct- 
ly upon  the  balcony.  There  is  an  incline 
from  the  balcony  to  the  ground  so  that 
patients  may  be  wheeled  down;  easy 
service  to  the  tent  wards  is  thus 
secured.  There  were  two  private  rooms, 
now  used  as  reception  rooms,  a  two-bed 
ward,  a  three-bed  ward,  and  a  four-bed 
ward. 

The  basement  is  devoted  to  domestic 
purposes,  with  kitchen,  nurses'  dining- 
room,  storage  for  supplies,  heating  plant, 
and  a  small  hand  laundry. 

The  second  story,  in  the  gambrel  roof, 
provides  sleeping  accommodations  for 
the  superintendent,  four  nurses,  and 
three  servants,  all  in  single  rooms,  with 
a  pleasant  sitting-room  at  the  west. 

As  high  pressure  steam  or  gas  was  not 
available  here,  electricity  was  employed 
for  the  diet  kitchen  and  for  sterilizing. 

The  original  hospital  building  is  fire- 


flR^T  f-LQOft.  PLAN' 


FIG.  239.     BARRE    (VERMONT)    CITY   HOSPITAL. 
Edward    F.    Stevens,    Architect. 


160 


THE  AMERICAN  HOSPITAL 


,i)£:coNDTlaPE.  Plan 


•TniCP  TlgdC-  Pj_es/M  - 

FIGS.  240  AND  241.     FLOOR  PLANS— BARRE  (VERMONT)   CITY  HOSPITAL. 
Edward    F.    Stevens,    Architect. 


proof  and  cost,  ready  for  occupancy,  less 
than  twenty  thousand  dollars. 

The  small  private  pavilion,  accommo- 
dating eight  private  patients,  relieves  the 
original  building  and  affords  room  for 
the  increasing  demand. 

The  second  story  of  the  new  wing,  also 
fireproof,  occupied  temporarily  by  nurses, 
is  so  constructed  that  with  slight  altera- 
tions the  private  service  can  be  increased 
to  sixteen  beds. 

A  small  city  hospital,  wher :  the  ground 
is  more  or  less  restricted,  certainly  should 
consider  only  fireproof  structure. 

The  Barre  (Vt.)  City  Hospital  (Figs. 
239-243)  is  another  solution  of  the  small 
hospital  problem.  Located  on  one  of  the 
hills  overlooking  the  city  and  taking  ad- 
vantage of  the  southeasterly  slope  for 
sunlight  and  air,  the  simple  brick  build- 
ing with  its  broad  brick  porch  bids  wel- 
come to  the  visitor  or  patient. 

On  the  entrance  level  or  ground  floor 


are  located  the  administration,  the  heat- 
ing and  kitchen  departments,  as  well  as 
the  Roentgen-ray  and  laboratory  depart- 
ments ;  and,  with  the  easterly  side  wholly 
above  ground,  light  and  air  are  not  sacri- 
ficed. 

The  grade  permits  entrance  to  the  first 
floor  on  the  westerly  side,  where  the  am- 
bulance door  is  located. 

With  all  the  general  offices  and  utili- 
ties placed  on  the  ground  floor,  the  first 
and  second  floors  are  left  free  for  the 
care  of  patients. 

In  planning  this  hospital  no  large 
wards  were  provided,  for  it  was  felt  that 
a  better  segregation  could  be  obtained 
with  smaller  wards.  On  the  first  floor 
were  located  four  three-bed  wards,  seven 
single  wards,  and  a  small  maternity  de- 
partment, entirely  isolated,  with  delivery 
room,  creche,  and  bathing  department. 

The  second  floor  is  almosr  wholly  de- 
voted to  private  patients  and  consists  of 


OF  THE   TWENTIETH   CENTURY 


161 


D/\R.Lt  CITY  nO^PlTAL- 

XjAttLt    - — ^ VtB-AAOMT^^ 

tDViAejD  riTtVTAO AtCnlTCCT  — 


FIG.    242.    BARRE    (VERMONT)    CITY   HOSPITAL. 
Edward    F.    Stevens,    Architect. 


one  four-bed  children's  ward  and  nine 
private  wards.  A  complete  operating  de- 
partment is  also  provided  on  this  floor, 
composed  of  two  operating  rooms,  an- 
aesthetic room,  nurses'  work  room,  ster- 
ilizing room  and  surgeons'  locker  rooms, 
all  shut  off  from  the  patients'  quarters 
and  planned  for  the  most  efficient 
service. 

On  each  floor  ample  serving  kitchens, 


sink  rooms,  bath  and  toilet  rooms,  linen 
storage  closets,  medicine  closets,  and 
nurses'  stations  are  provided. 

Large  airing  balconies  at  the  south  af- 
ford opportunities  for  patients  to  be 
wheeled  into  the  open  air.  All  doors  are 
wide  enough  for  beds,  and  all  beds  are 
provided  with  trucks,  while  the  elevator 
connects  all  floors. 

Perhaps  the  most  interesting  feature 


FIG.    243.        VIEW    OF    EXTERKJR-BARRE    (VERMONT)    CITY    HOSPITAT. 
Edward  F.  Stevens,  Architect. 


162 


THE  A^IERICAX  HOSPITAL 


FIG.    244.     BEXJAMIX    STICKXEY    CABLE    MEMORIAL    HOSPITAL. 


of  this  thirty-two-bed  hospital  is  the  ex- 
tensive roof  ward,  equipped  with  all  the 
conveniences  and  accessories  of  indoor 
wards  and  commanding  a  wonderful 
view  over  the  city  and  the  adjoining  hills. 

The  materials  of  construction  are 
common  brick,  granite  and  terra  cotta, 
with  floor  construction  of  iron  and  con- 
crete ;  the  interior  walls  of  hollow  tile ; 
the  finished  flooring  is  of  terrazzo,  ce- 
ment, and  linoleum :  the  finish  is  simple, 
the  windows  wide,  and  the  coloring  of 
the  inside  cheerful  and  attractive.  The 
equipment  is  simple,  but  fulfills  every 
requirement  of  modern  science. 

Diftering  from  the  last  example,  where 
the  grounds  were  more  or  less  restricted, 
the  Benjamin  Sticknex  Cable  Memorial 
Hospital  TFigs.  244-247)  in  Ipswich, 
Mass.,  is  erected  in  the  center  of  a  ten- 
acre  lot.  (See  Chapter  X\'III  on  land- 
scape architecture.)  The  ample  space 
around  the  building,  coupled  with  the 
natural  beauty  of  the  site,  gives  the  archi- 
tect more  than  usual  opportunities  for 
placing  the  rooms  to  the  best  advantage. 
The  building  faces  the  north,  or  toward 
the  town  proper,  but  practically  all  the 
rooms  for  patients  are  on  the  south,  over- 
looking the  beautiful  valleys  and  hills  in 
that  direction. 

The  building,  of  fireproof  materials,  is 
designed  in  the  early  Georgian  style  so 
common  in  the  old  New  England  towns. 
It  accommodates  twenty  patients  on  the 
first  floor,  and  the  second  floor  is  also 
available  for  use  of  patients. 

The  ground  floor  contains  the  kitchen. 


dining-rooms,  X-ray,  morgue,  heating, 
and  storage  rooms ;  for  the  present,  the 
second  story  is  set  apart  for  nurses  and 
for  a  small  isolation  department. 

To  give  assurance  of  security,  a  low 
brick  wall  is  built  around  the  patients' 
court,  upon  which  three  airing  balconies 
open.  These  airing  balconies,  projecting 
to  the  east  and  west,  cut  off  the  cold 
winds  from  the  north  and  east. 

The  plan  is  simple :  one  enters  through 
the  memorial  entrance,  which  is  finished 
in  Colonial  detail,  passes  up  two  steps 
to  the  main  corridor  and  thence  into 
the  private  patients"  day  room,  or  out 
into  the  patients'  court. 

On  the  east  end  of  the  building  is 
located  the  men's  ward,  the  operating 
department,  and  the  ambulance  entrance ; 
on  the  west,  the  women's  and  maternity 
wards ;  on  the  northeast,  the  children's 
ward ;  on  the  south  are  four  private 
rooms ;  and  on  the  north  the  utilities. 

The  small  Greenville  Hospital  (Figs. 
248  and  249)  at  Greenville,  Me.,  built  to 
meet  the  needs  of  the  lumber  industries 
of  the  A'icinity,  at  the  figure,  approx- 
imately, of  twenty-five  thousand  dollars, 
is,  perhaps,  as  complete  as  any  hospital 
of  a  like  cost.  It  is  somewhat  unduly 
expensive,  but  was  built  in  the  season 
of  1916-1917  when  all  materials  were 
at  a  maximum. 

The  problem  on  the  Melrose  Hospital 
(Figs.  250-257)  at  Melrose,  ]Mass.,  was 
to  build  a  fifty-  to  sixty-bed  hospital  on 
a  noisy  street  corner,  with  trolley  lines 
on  two  streets. 


OF  THE   TWENTIETH   CENTURY 


163 


SECOXD    FLOOR   PLAX. 


n 


PATICnT-S'   TCERACL 


TieST    rLOOC  PLAh» 

5CALE. 


FIGS.   245 


AND   246.     BEXJAMIX   STICKXEY   CABLE   MEMORL-\L   HOSPITAL.  IPSWICH,   MASS. 
Edward  F.   Stevens,   Architect. 


164 


THE  AMERICAN  HOSPITAL 


The  buildings  were  set  well  back  from 
the  street,  the  operating  portion  only  be- 
ing near  the  street,  the  buildings  being 
so  planned  as  to  bring  the  patients  away 
from  the  noisy  corner.  There  are  three 
buildings  in  this  group. 

In  the  basement  of  the  administration 
building  are  the  Roentgen-ray  and 
laboratory    departments,    the   pharmacy, 


store  rooms,  autopsy  and  lecture  rooms, 
and  rooms  for  male  help.  On  the  first 
floor  are  all  of  the  administrative  offices, 
the  superintendent's  suite,  and  the  oper- 
ating department. 

The  second  floor,  however,  is  devoted 
to  the  care  of  patients — 1st,  in  private 
rooms  and  suites ;  and  2d,  in  the  ma- 
ternity department,  which  consists  of  a 


OF  THE  TWENTIETH  CENTURY 


165 


JtuviMo       _         Kitchen 


b.:iHL_^ 


fiUJT  fLOOL  Kan 


Mtft  iNG     Room, 


THE     QHtENVlLLE 
QUEENVILLL 


I 
I 

Jl 


HOSPITAL 


FIG.  248. 


three-bed  ward,  a  delivery  room,  creche, 
and  wash  room — all  isolated  from  the 
other  portions  of  the  hospital. 

One  serving  kitchen  serves  all  patients 
in  this  building. 

The  ward  pavilion  is  joined  to  the  ad- 
ministration building  by  a  well-lighted 
corridor.  On  the  first  floor  are  the  three 
main  wards — men's,  women's  and  chil- 
dren's— and  five  private  rooms,  and  on 
the  second  floor  are  ten  private  rooms, 
with  the  usual  service. 

All  of  the  wards  and  private   rooms 


on  the  first  floor  open  directly  onto  air- 
ing balconies,  which  are  so  separated 
that  the  patients  on  one  balcony  are  not 
visible  to  those  on  another. 

On  the  second  story  a  large  roof  ward 
has  been  provided  for  the  treatment  of 
pneumonia  cases,  as  well  as  for  use  by 
ambulatory  cases. 

The  heating  plant  and  laundry  are 
housed  in  a  separate  building,  which  also 
affords  sleeping  accommodations  for  fe- 
male servants.  The  nurses  are  pro- 
vided for  in  an  adjoining  estate. 


5E.C0NP'  Tlooij.  Plan 


THE     qilEENVJLLE      HOJPITAL 
QR.EENVILLL  A\A1NE 


FIG.  249. 


166 


THE  AMERICAN  HOSPITAL 


r 


h- 
M 
1- 


JiECVICE 

Building 


Kitchen 


Oplcating 
Dept 


Pavilion 


CONKECTI^C  COC-e.lDOC 


ADMlNliTtATION 


Allium 

8ALC0lf 


Plot    PLAN 

MELft-0-5E      HOi>l>ITAL 
MELfe.Oi£  ' '  MAi^ 

EDV<A6.t>f    iTtVENi     AfcCHITtCT 

Ronton      • '    MA66 


Lebanon      -5T-!i,LET 


FIG.  250. 


OF  THE   TWENTIETH   CENTURY 


167 


Adminuthation  Building 

MEL^OJE   ~  '  H0-5?ITAL 

EDV/Ati)  T  JTEVEN^         AtLCHITECT 
ioiTOH    ■ '■ •    MA6i. 


FIG.  251. 


I         I  t  BALCON-f 


PAVILION 

MEL^OjE  ~    Hospital 

MEL^OJE    -         IAAS5- 

EDWAfeD  y  JTEVEHJ           AtCHITeCT 
bciTON    • 1    I\A53 


f  Hi-5T    FtOOt  ^LAM 

JcAut    ■  ■  ■  M^  ■orM? 


FIG.  2S3. 


168 


THE  AMERICAN  HOSPITAL 


ADIAI MUTATION  BuiLDING 
HEL-LOJE  -  H0-3P1TAL 
KfL^O^E     -         MA^^. 

imAU>  r  JTEVEN^  At.CHIT£CT 

fco^TON    ' — '    fAA55. 


Pavilion 

KEL^O^t  ~     HOJflTAL 
EJ)V(At.6  f-  Jtevenj        Architect 

JOiTON     <— '    WA5i 


Second  fLooft.'^LAN 

FIG.  254. 


OF  THE  TWENTIETH  CENTURY 


169 


FIG.    255.      MELROSE    HOSPITAL,    MELROSE,    MASS.      EXTERIOR    VIEW. 
Edward  F.   Stevens,  Architect. 


FIG.   256.     MELROSE  HOSPITAL.     OPEK  AIR   CORRIDOR. 

Edward  F.   Stevens,  Architect. 


170 


THE  AMERICAN  HOSPITAL 


FIG.   257.     MELROSE   HOSPITAL.     PRIVATE   WARD. 


TrI  L  =  J031AIi  •  f)  Ti1oriA3  •  H03PiTAL- 

PE,AD0DY.  ?\A^5AGH03ETTO>. 

■l\E~iDALL  TAYLOR ■SOT&VEN.5- 

•towAR-o  -p  .5TcvfcM5• 


^RC^lTECT.J-.DO:5To^^> 


Plajsc   Of  ri"R5T.rLooia 


FIG.  258. 


OF  THE   TWENTIETH   CENTURY 


171 


The  problem  of  the  Josiah  B.  Thomas 
Hospital  (Figs.  258-260)  at  Peabody, 
Mass.,  was  different.  The  land  sloped  to 
the  north,  making  that  exposure  the 
important  one  to  study.  The  operat- 
ing room  window  was  made  the  archi- 


tectural feature.  Otherwise  the  build- 
ing is  a  simple  treatment  of  the  small 
hospital  problem.  A  very  complete  out- 
patient department  was  secured  under 
the  surgical  end  of  the  building. 

As  in  the  case  of  Dr.  AMUiams'  Sana- 


TOe.-»  J05  iaH"  b  "Thomas  °  H03PITAI:,- 

PEAS'ODY,  7^vA65ACHC  J  J)  £T  T  6. 

•n  EN  DALL  TAYLOR.  ZfOTtVCNi  ^^^-'-rT',.   fSnUHN 


Pla^L    of  a)tC02tP  rLODE 


FIG.  259. 


ilG.   2oU.     JOSIAH   B.   THOMAS    H(_»SPITA].,    PEABODY,   MASS. 
Kendall,  Taylor   &  Stevens   and   Edward   F.   Stevens,  Architects. 


172 


THE  AMERICAN  HOSPITAL 


tarium  at  Macon,  the  Mason  Hospital 
(Figs.  261-265)  at  Clarksburg,  W.  Va., 
is  mainly  for  the  private  practice  of  the 
founder. 

The  hospital  is  built  on  a  somewhat 
restricted  site. 

The  plans  are  self-explanatory.  Pro- 
vision is  made  for  a  rather  extensive 
out-patient     department     in     connection 


with  the  X-ray  and  laboratory.  The 
operating  department  is  set  apart  from 
the  administration,  and  is  reached  either 
from  the  ambulance  entrance  at  the  rear 
or  through  the  main  entance  at  the 
front. 

This  small  fireproof  hospital  is  self- 
contained,  housing  all  departments  except 
the  nurses. 


GE.0UNI7     rLooJL    Plan 


Tttt  Ma/on  Ho/pi tal 

CLAM/BURG  -We/t  VmmiA 

tPlvftep      f-       /TtVtN/   ~  AtcnlTECT 

Boston-  MA// 


FIG.  261. 


Tirur       fLooE.   -Plan 


^t^^ 


FIG.  262.     MASON  HOSPITAL,  CLARKSBURG,  W.  VA. 


OF  THE  TWE>^TIETH   CEXTURY 


173 


yeCOND.c   TniED   fLOOE,    -Plan^ 


The  Ma/on  tto/piTAL 

CLA&K/BUIIG  -  Wt/T  VIB.G1NIA 

tpwASp      f-        >-TfcV&N^  -  AE.CH1TECT 

Boston-  M<y> 


FIG.   263. 


f  oua,Ttt    Tlooe,  Plan 


Ttit    Ma /ON    HO/PITAL 
CLAEK/5URG  -  Wt/T  Virginia 

fPWAB.0       f"         ^TCVEN^    -  flEcniTCCT 


FIG.  264. 


174 


THE  AMERICAN  HOSPITAL 


FIG.  265. 


OF  THE   TWENTIETH  CENTURY 


175 


CHAPTER  XIII. 


^f\t  i^ursiesi'  i^eisibence 


Perhaps  next  in  importance  to  the 
care  of  the  patient  is  the  care  of,  the 
nurse,  for  to  do  her  best  and  give  com- 
fort and  help  to  the  sick  a  nurse  must 
conserve  her  own  heahh  and  strength. 
When  off  duty  she  must  be  able  to 
go  out  of  the  environment  of  the  sick 
room,  out  of  the  sound  of  suffering,  out 
of  the  smell  of  iodiform,  and  in  fact  out 
of  the  hospital  atmosphere. 

Any  hospital  of  considerable  size 
should  have  its  nurses'  residence.  This 
should  be  a  separate  building,  not  too 
remote  from  the  hospital,  but  far  enough 


away  so  that  the  noises  of  an  entertain- 
ment, a  dancing  party  or  a  romp  will 
not  disturb  the  patients. 

The  more  attractive  and  homelike 
this  building  can  be  made  and  the  more 
alluring  it  can  be  made  to  the  young  wo- 
man who  is  taking  up  nursing,  the  bet- 
ter will  be  the  class  of  women  who  will 
come  to  it  and,  in  the  end,  the  better  will 
be  the  care  that  the  patient  Vv^ill  receive. 

No  matter  how  small  the  appropriation 
for  a  nurses'  home,  one  should  plan  for 
nothing  but  single  rooms.  The  nurse's 
work  on  duty  is  most  exacting,  and  every 


lO     5.     o      *      10     lt>     20    25    5o    i5 


M25 


FIG.    270.    HOSPITAL    FOR    SICK    CHILDREN.    NURSES'    RESIDENCE.    GROUND    FLOOR. 


iOVTM 


FIG.    271.    HOSPITAL    FOR    SICK    CHILDREN.     NURSES'    RESIDENCE.     FIRST    FLOOR. 


176 


OF   THE   TWENTIETH   CENTURY 


NUR.5E5  RlSIDLNCE 
Bridgepor-T  Hospital 
Bridgeport       Conn 

tDWA^D  f  ilLVtM^    AR-CHITtCT 
Boston.   /'\A5i. 


"miR17.TL00R  ?LAN 

5CBLE.  i 
M 0 


f  IR5T  ruooR  vm 

"     — -       $ ^5 


FIG.  273. 


OF  THE   TWENTIETH   CENTURY 


177 


<  2 


o  5 


178 


THE  AMERICAN  HOSPITAL 


FIG.    276.    BRIDGEPORT    HOSPITAL.    NURSES'    RESIDENCE.    VIEW    FROM    REAR. 


FIG.  277.    BRIDGEPORT  HOSPITAL.    NURSES'   RESIDENCE.    STUDY   ROOM. 


OF  THE  TWENTIETH   CENTURY 


179 


FIG.     278.    BRIDGEPORT    HOSPITAL.    NURSES'     RESIDENCE.    ROOM    OF    SUPERINTENDENT 

OF  NURSES. 


nurse,  whether  pupil  or  graduate,  should 
have  her  own  separate  room.  It  need 
not  be  large,  only  enough  for  a  single 
bed,  closet,  dresser,  and  study  desk. 
These  can  be  fitted  into  an  area  8'-6"  by 
12'-0".  The  closet  should  be  large  and, 
if  possible,  lighted  by  a  window.  An 
adjustable  electric  drop  light  can  be 
made  to  serve  both  for  study  and  toilet 
light.  This  is  the  minimum  amount  of 
light,  and  of  course  can  be  increased 
to  any  extent. 

The  living  room  should  be  homelike 
and  refined.  It  should  have  fireplace, 
settle  seats,  and  cozy  corners.  There 
should  be  a  number  of  reception  rooms 
where  the  nurses  may  meet  their  friends, 
and  a  sitting  or  study  room  on  each  floor. 

There  should  be  a  small  tea  kitchen 
with  gas  stove  and  other  conveniences, 
where  the  nurses  may  prepare  an  occa- 
sional "spread"  for  the  refreshments  of 
an  evening  party. 


A  large  trunk  room  is  necessary,  with 
easily  accessible  racks  for  trunks.  A 
petty  laundry,  equipped  with  set  tubs 
and  ironing  boards,  should  be  provided 
in  the  basement. 

Class  rooms  for  demonstration  and 
class  work  should  be  planned  for  in  a 
well-lighted  section  of  the  building. 
These  class  rooms  should  be  well  equip- 
ped for  demonstration  in  all  kinds  of 
hospital  technique. 

In  the  smaller  hospitals,  a  portion 
of  the  nurses'  residence  is  sometimes  set 
apart  for  the  housing  of  servants.  The 
same  general  conditions  should  exist  for 
servants  as  for  nurses,  but  some  of  the 
refinements  need  not  be  furnished,  al- 
though a  separate  room  for  each  indi- 
vidual should  be  provided.  Of  course, 
where  the  size  of  the  institution  warrants, 
there  should  be  a  separate  home. 

The  same  conditions  apply  to  internes' 
and   orderlies'    quarters.      The   internes, 


180 


THE  AMERICAN  HOSPITAL 


i"IG.    279.     BRIDGEPORT    HOSPITAL.     NURSES'    RESIDENCE.    TYPICAL    NURSE'S    ROOM. 


Airing 
Balco.vt 

r 


^ 


^tti  I 


C    O    E.     R-     I     D     O      R- 


S^^^^^z:7p^^p>rp^p;vm^- 


i£  1;  iNvlit  f 


FIG.    280.    ST.    LUKE'S    HOSPITAL,    JACKSONVILLE.     NL'RSES'    RESIDENCE.      FLOOR   PLANS. 


OF  THE  TWENTIETH  CENTURY 


181 


,.  irp_i?-=-'4/<&-  .-rr  r.  - '.  f  !^« 


FIG.    281.    ST.    LUKE'S    HOSPITAL,    JACKSONVILLE,    FLORIDA.     NURSES'    RESIDENCE. 


FIG.    282.    ST.    LUKE'S    HOSPITAL,    JACKSONVILLE.    NURSES'    RESIDENCE.    VIEW    JN 

SLEEPING  PORCH. 


182 


THE  AMERICAN  HOSPITAL 


FIRST    FLOOR    PLAH 
^  - '—   T      •■      r  T 


LxoriARD  MOK5E  no^riTAL 

I-TAjTICK.    ,    l-tASSACMXJSE-TTS. 


FIG.  283. 


who  are  college  men  accustomed  to  re- 
finement, should  have  comfortable  quar- 
ters, sufificiently  removed  from  the  pa- 
tients not  to  disturb  or  be  disturbed. 

There  must  be  ample  toilet  facilities 
on  each  floor — one  tub  and  one  water- 
closet  for  each  five  or  six  nurses,  one 
wash  basin  to  every  four.  There  should 
be  both  shower  and  tub  baths.  If  pos- 
sible, bowls  with  hot  and  cold  water 
should  be  placed  in  every  room.  There 
should  be  a  slop  sink  and  broom  closet  on 
each  floor. 

Space  should  be  set  aside  for  nurses 


on  night  duty,  preferably  in  the  upper 
story,  away  from  the  noise.  These 
rooms  should  be  on  a  separate  corridor. 

An  infirmary  for  sick  nurses,  fitted  as  a 
hospital  unit,  should  be  provided  in  every 
large  home. 

There  should  be  a  piazza  and  balconies 
wherever  space  and  money  will  permit, 
preferably  on  the  sunny  side.  If  the 
roof  be  flat,  arrangement  should  be  made 
to  use  it  for  outdoor  sleeping  as  well 
as  for  recreation. 

In  the  larger  homes  for  nurses,  it  may 
be  desirable  to  provide   a   separate  kit- 


TiUR5E5  nOME  ^  TH^ 

Ldohard  "Mc^^e,  no5nmL 


IvTAnOP:-  , 


SECOMD  FLOOR    F^API 


T-r  ASS>AC«U5E.T  TS . 

^AKCfllTECTi 


FIG.  284. 


OF  THE   TWENTIETH   CENTURY 


183 


FTR^T  .FLOOR.  PLA.\ 


J.MAXCHESTER,HAYNES  HOMEFOP.NL'RSES. 

KENDiLL.TiYLORa-JTEVtNS  .         EtJUiRD    PSTtVENl 


FIG.  285. 


chen  and  dining-room  in  the  building. 
In  small  institutions  it  is  more  economi- 
cal to  place  the  nurses'  dining-room  near 
the  main  hospital  kitchen. 

Dr.  Donald  Mackintosh,*  in  writing  on 
hospital  construction,  places  the  nurses' 
residence  of  Hospital  for  Sick  Children 
(Figs.  270-272),  as  the  best  example  of 
convenience,  and  the  plans  are  reproduced 
here.  It  is  certainly  a  model  home,  with 
its  great  reception  hall,  dining-rooms  and 
kitchen,  its  swimming  pool  and  gymna- 
sium, its  sitting  and  study  rooms,  etc. 


*"Construction,  Equipment  and  Management  of  a 
General  Hospital."  Published  by  Wm.  Hodge  &  Co., 
Glasgow. 


The  nurses'  residence  at  the  Bridge- 
port (Conn.)  Hospital  (Fig.  19),  plan- 
ned on  the  L-shape  with  provision  for 
future  extension  completing  the  U-form, 
is  built  on  the  adjoining  lot  to  the  hos- 
pital. 

Reception  rooms  adjoin  the  entrance, 
and  the  social  and  lecture  rooms  are 
connected.  The  suite  of  the  superin- 
tendent of  nurses  is  at  the  north w^est 
corner,  and  consists  of  two  small  rooms 
and  bath.  There  is  a  study  room  on 
each  floor.  A  small  infirmary  of  four 
rooms  is  provided  for  the  care  of  the 
sick  nurse.  The  roof  garden  is  sufficient- 
ly large  for  all  to  sleep  in  the  open. 


5ECONI)  FLOOR,  PL\N 


J.MXNCHESTER^Eft^TS  HONE  FOR  NURSES. 

Ar-Goxv City  Hospital.  M'G\:i:Jj^.  Me., 

KfDlLL.T.  rtOR  i  S'lvjni  :        E.:^AKD   F  5TEVE  »i'. 


FIG.  286. 


184 


THE  AMERICAN  HOSPITAL 


- 3 c^AvLS:    \  / It.'  1- a. 

FIG.    287.    PROPOSED    HELP'.S    BUILDING. 
Edward  F,   Stevens,   Architect. 


While  all  hospital  buildings  should  be 
fireproof  for  the  safety  of  the  helpless 
patients,  it  is  sometimes  possible  to  give 
the  maximum  amount  of  convenience  at 
a  minimum  cost  by  making  this  section  of 
the  institution  non-fireproof.  This  was 
done  in  the  nurses'  residence  of  the  St. 
Lukes  Hospital  (Fig.  280)  at  Jackson- 
ville. This  was  built  at  a  very  low  cost, 
owing  to  its  simple  lines,  being  planned 
on  a  nine-foot  unit  system,  so  that  all 
partitions  and  piping  came  in  verticals, 
one  above  the  other.  All  the  necessary 
rooms  were  provided  for  the  comfort 
and  pleasure  of  the  nurses,  including  a 
broad   roof   balcony   for   sleeping.     The 


outer  finish  of  this  building  is  the  same 
as  the  others  of  the  group,  which  are 
fireproof. 

The  plans  for  the  nurses'  residence  of 
the  Leonard  Morse  Hospital  and  of  the 
Augusta  (Me.)  City  Hospital  are  here 
shown. 

One  example  of  help's  building  on  even 
more  economical  lines  is  that  designed 
for  Kings  County  Hospital  (Figs  287- 
289).  New  York  City,  Department  of 
Charities. 

This  is  planned  on  an  eight-foot  unit 
basis  and  has  all  the  necesary  common 
rooms,  toilets  and  staircases  for  a  build- 
ing: of  this  nature. 


3E£d/<  li  ?r  7>Hfeb  TLoois.  fiLA^s 

FIG.    288.    PROPOSED    HELPS'    BUILDING. 
Edward   F.   Stevens,   Architect. 


■HEicit-rr      :3; 


2^^ 


j^jTifExir  Tu^   Te.QOT 


^ZZi 


iX       tooT       ■SA^uS"ntAT>E. 


Tli-E     -aoO-F      CBM.US-EMiE 


.  f4,A.T    T-oov 


FIG.    289.    PROPOSED    HELP'S    BUILDING. 
Edward    F.    Stevens,    Architect. 


OF  THE  TWENTIETH  CENTURY 


185 


CHAPTER  XIV. 


llitcfjen  anb  Xaunbrp 


The  location  and  plan  of  the  kitchen 
building,  so-called,  are  most  important 
factors  in  the  success  or  failure  of  an 
institution.  The  kitchen,  whether  an 
isolated  building  or  a  department  in  a 
general  building,  should  be  so  located 
that  food — hot,  palatable  food^ — can  be 
readily  transported,  with  the  least  de- 
lay and  the  least  amount  of  handling, 
from  the  place  where  it  is  cooked  to 
the  patient's  tray  or  dining  table.  To  do 
this,  certain  conditions  must  exist — 

(a)  A  central  location, 

(b)  Adequate    means    of    transport- 

ing, 

(c)  Serving  kitchens  of  sufficient  size 

and  equipment  to  care  for  and 
distribute  food  properly. 

If  occupying  only  a  portion  of  the 
building,  the  kitchen  should  be  on  the 
ground  floor  or  on  the  highest  floor. 
Many  of  our  best  hospital  superintend- 
ents contend  that  the  kitchen  should  be 
on  the  upper  level,  while  others  agree 
that,  owing  to  a  greater  facility  for  de- 
livery of  supplies,  the  lower  basement 
level  is  the  more  economical.  With  a 
refrigerating  system  and  good  elevator 
service,  the  upper  level  kitchen  has  cer- 
tain advantages,  the  chief  being  the  free- 
dom from  odors  of  cooking  and  the  ex- 
clusion of  tradesmen  from  the  kitchen. 
On  the  other  hand,  the  low  level  kitchen 
affords  quicker  delivery  of  supplies, 
quicker  disposal  of  waste  products,  and, 
as  the  heavier  demand  is  apt  to  be  on 
the  lower  floors,  quicker  service  to  the 
greatest  number  of  patients. 

The  kitchen  should  not  be  too  large 
or  too  small.  If  too  large,  time  is  wasted, 
owing  to  the  distance  traveled ;  if  too 
small,  it  will  be  too  crowded  to  secure 
the  best  results.  In  other  words,  the 
kitchen  should  be  planned  to  meet  the 
needs  of  the  institution,  not  forgetting, 
however,  its  probable  growth. 

The  hospital  kitchen  should  be  plan- 


ned like  a  modern  factory — that  is,  to  re- 
ceive the  raw  material  and  to  deliver 
the  finished  product  (which  is  palatable 
food)  with  as  few  lost  motions  and  de- 
lays as  would  be  expected  by  a  modern 
manufacturer  in  his  factory.  If  there  is 
any  delay  by  the  way,  there  is  a  loss  in 
food  value,  and  the  patient  has  in  con- 
sequence less  of  vital  energy  than  with 
efficient  service.  The  same  thing  applies 
not  only  to  the  patient  but  to  the  nurse, 
the  attendant,  the  servant,  ^.nd  all  along 
down  the  line.  An  underfed  nurse  or 
domestic  cannot  do  her  best,  so  that  as 
a  purely  business  proposition  it  pays  to 
feed  well  everybody  connected  with  the 
institution. 

In  the  kitchen,  the  building  should  be 
planned  around  the  equipment.  The 
ranges,  which  are  perhaps  the  apparatus 
most  constantly  in  use,  should  be  placed 
in  the  most  convenient  place — generally 
in  the  center,  where  all  sides  are  avail- 
able. 

For  fuel,  circumstances  differ,  and 
what  is  best  in  one  part  of  the  country 
may  not  be  good  in  another.  Gas,  either 
natural  or  artificial,  in  the  long  run  is 
not  only  the  most  economical  but  the 
most  efficient.  There  is  no  dust,  no  dirt, 
no  unsightly  or  unsanitary  coal  scuttle  in 
the  way.  The  modern  blast  burner  ranges 
give  the  same  quality  of  heat  as  the 
best  coal  range.  Broilers  or  toasters  are 
equally  good  in  gas,  and  these  should  be 
placed  on  the  same  line  and  near  the 
range.  In  the  institutions  in  the  west 
crude  oil  is  used  both  for  kitchens  and 
for  heating  boilers. 

With  electricity  at  a  minimum  cost 
much  work  can  be  done  with  that  me- 
dium. 

Much  of  the  cooking  formerly  done 
on  the  range  can  now  be  more  efficient- 
ly done  by  steam.  In  the  pressure  steam 
cooker  practically  all  vegetables  can  be 
prepared.      This    cooker    should    be    of 


186 


THE  AMERICAN  HOSPITAL 


V 

i 
« 

1 

> 

■I 

OF  THE  TWENTIETH  CENTURY 


187 


sufficient   size  and   of   proper   design  to 
do  the  work  easily. 

The  steam  stock  kettles  as  made  and 
used  in  Europe  are  much  finer  in  work- 
manship and  more  attractive  than  those 
made  in  America.  American  manufac- 
turers have  not  sufficiently  considered 
the  hygienic  construction  of  rr.any  of  our 
hospital  appurtenaces. 

For  the  cooking  of  cereals,  the  tilting 
kettles  are  the  simplest  in  action,  being 
easily  manipulated  and  cleaned. 

All  steam  apparatus  should  be  planned 
to  withstand  a  pressure  of  at  least  sixty 
pounds  per  square  inch.  To  that  end, 
a  reducing  valve  for  the  kitchen  steam 
supply  should  be  provided. 

The  kitchen  sinks  should  be  planned 
for  their  special  uses — deep  sinks  for 
pots  and  pans,  and  shallow  sinks  for 
smaller  utensils.  \"egetable  sinks  can 
be  grouped  together.  A  small  sink  in 
the  cook's  table  often  saves  steps. 

The  many  labor-saving  devices  driven 
by  the  small  motor,  such  as  meat  chop- 
pers, bread  and  cake  mixers,  ice-cream 
freezers  and  ice  crushers,  vegetable  and 
fruit  parers,  make  the  work  of  preparing 
food  vastly  easier.  Power  dish-washers 
save  much  time  and  many  dishes.  Steam 
tables  have  become  a  necessity  in  keep- 
ing food  palatable. 

All  cabinets  and  racks  should  be  open 
and  easy  to  clean.  Dish  cabinets  and 
dish  warmers  should  be  at  a  proper 
height  from  the  floor  to  prevent  extra 
muscular  strain  in  removing  the  dishes. 

Every  hospital  of  considerable  size 
should  have  a  room  for  the  preparation 
of  special  diets.  This  room  should  be 
near  but  not  a  part  of  the  kitchen.  It 
must  also  be  near  the  food  lifts  and  the 
route  of  service.  It  is  customary  to  use 
the  diet  kitchen  for  a  teaching  kitchen 
■for  the  nurses  in  training;  and  where 
this  is  the  case,  cabinets,  fitted  for  in- 
dividual service,  are  sometimes  pro- 
vided. 

The  serving  kitchen  has  a  place 
among  the  important  rooms  of  a  hos- 
pital, for  in  this  room  the  trays  for  the 
food  are  prepared,  and  from  it  the  food 
is  distributed.  If  the  serving  kitchen  is 
conveniently  arranged,  the  food  is  more 
likely  to  be  brought  to  the  patient  in  the 


best  condition.  And  what  a  difference 
even  the  looks  of  a  tray  makes  to  a  deli- 
cate patient  I 

How  often  one  hears  it  said  about  a 
hospital,  "The  operating  room  technique 
is  perfect;  the  nursing  is  all  that  can  be 
desired ;  but  the  food — and  the  service !" 
Good  food,  properly  served,  goes  a  long 
way  toward  offsetting  deficiencies  in 
other  departments. 

The  serving  kitchen  should  be  of  suf- 
ficient size  to  do  the  work  properly.  In 
one  of  the  earlier  hospitals  designed  by 
the  writer,  the  planning  of  which  was 
directed  largely  by  the  building  commit- 
tee, the  desire  on  their  part  to  make  every 
inch  available  for  patients  made  it  neces- 
sary for  the  serving  kitchen  to  be  so  re- 
duced in  size  that  it  has  always  been  a 
great  drawback  to  the  best  serving  of 
meals.  A  little  more  space  devoted  to 
this  room  would  have  added  greatly  to 
the  comfort  of  both  nurse  and  patient. 

What  are  the  essentials  and  what  are 
the  luxuries  of  a  serving  kitchen?  The 
essentials  are : 

1st,  Proper  Location — Remember  that 
a  ward  serving  kitchen  is  a  very  busy 
place  three  times  a  day.  ]\Iany  utensils 
must  be  handled,  washed  and  put  away , 
food  trucks  are  going  and  commg:  so 
that  this  room  should  be  located  remote- 
ly or  in  such  a  way  that  the  sound  from 
the  room  is  cut  oft"  from  the  patients. 
This  may  be  accomplished  by  having  the 
serving  kitchen  entered  from  a  side  cor- 
ridor, as  in  the  ]\Ielrose  Hospital  CFig. 
253)  ;  or  through  a  vestibule,  as  at  the 
Royal  Victoria  (Fig.  66)  ;  or  by  having 
it  entirely  apart,  as  at  the  Bridgeport 
Hospital  fFig.  45). 

2nd,  Room  Enough  to  Lay  Trays — 
There  should  be  room  enough,  and  the 
room  should  be  so  planned  that  no  one 
will  be  crowded  while  preparing  the 
meals.  If  the  building  is  a  multi-story 
building,  special  food  lifts,  large  enough 
to  carry  a  food  car.  should  be  provided, 
and  space  enough  to  bring  the  car  into 
the  room  to  discharge  it. 

In  moving  the  food  from  the  kitchen 
it  should  be  handled  as  little  as  possible. 
To  that  end,  the  food  truck  loaded  in  the 
kitchen  should  not  be  disturbed  until  it 
reaches  the  serving  kitchen.     This  food 


188 


THE  AMERICAN  HOSPITAL 


truck  can  be  taken  on  the  serving  ele- 
vator; or,  better  still,  special  food  ele- 
vators may  be  provided,  working  auto- 
matically from  the  sending  point  on  the 
kitchen  level.  These  food  trucks  can 
be  kept  warm  by  electricity,  hot  water, 
or  hot  soapstone.  The  one  shown  in 
the  illustration  (Tig.  41  )  is  heated  by 
soapstone. 

V'd,  Keeping  Food  Ji'ann  or  Cold — - 
The  steam-table  is  almost  indispensable 
for  keeping  food  hot,  and  should  be  pro- 
vided with  a  gas  plate  and  warming 
closet. 

Tray  racks  of  sufficient  capacity  for 
holding  all  trays  should  be  provided. 
These  racks  should  be  mounted  on  ball- 
bearing casters,  so  that  if  required  the 
trays  can  be  brought  en  masse  to  the 
ward  door.  The  use  of  the  portable  hot 
table  is  growing  in  popularity.  For  some 
classes  of  patients  this  makes  the  most 
satisfactory  method  of  serving. 

Refrigerators  should  be  built  or  select- 
ed with  care  and,  with  due  regard  for 
hygiene,  should  be  either  porcelain  or 
tile  lined,  and  should  hai'e  properly 
trapped  drains.  If  there  is  a  refrigerat- 
ing plant,  by  all  means  extend  the  pipes 
to  these  small  serving-kitchen  refriger- 
ators. 

4th,  Utensils  and  Their  Cleaning — 
Among  the  luxuries  of  the  serving 
kitchen  might  be  counted  special  &gg 
boilers,  coffee  percolators,  individual 
serv-ices  for  private  patients,  special 
china  and  glass,  hot  plates  and  more  at- 
tractive trays  and  linen. 

AVhere  the  dishes  from  patients  with 
infectious  diseases  are  cared  for,  the 
dish  sterilizer  is  absolutely  essential. 

The  location  and  size  of  the  sink  is 
important.  There  should  be  an  ample 
drainboard  and  the  sink  set  high.  The 
tendency  of  the  plumber  is  to  place  the 
sink  at  his  standard  height,  making 
everyone  who  uses  it  stoop,  while  plac- 
ing it  a  few  inches  higher  Avould  save 
many  a  backache.  The  material  for  the 
sink  is  largely  a  matter  of  fancy.  Iron, 
porcelain  and  soapstone  are  used. 

_  A  suitable  receptacle  should  be  pro- 
vided for  the  dishes  and  utensils  after 
they  are  cleaned.  The  cabinet  should  be 
hygienic  in  its  construction,  easilv 
cleaned,    with    slanting   top   so   that  the 


dust  may  be  seen  and  removed.  It  should 
contain  drawers  and  cupboards  enough 
to  store  the  cutlery  and  silver  needed  in 
the  section  served  by  ward  kitchen. 

In  General — The  room  should  be  tiled 
to  a  height  of  four  feet.  If  the  ex- 
pense of  this  is  prohibitive,  place  tiling 
at  least  back  of  all  plumbing  fixtures. 

The  floors  should  be  of  a  non-porous 
substance,  like  magnesite,  terrazzo,  or 
tile;  if  of  tile,  a  gray  or  buff'  is  much 
easier  to  care  for  than  white. 

Dining  Rooms.  The  dining-room  for 
nurses  (if  in  the  same  building  with  the 
kitchen)  should  be  in  a  well-lighted  por- 
tion of  the  building,  and  some  attention 
should  be  paid  to  the  decoration  and  ar- 
tificial illumination.  A  serving  room, 
equipped  with  steam  table  and  coffee 
urns,  should  be  placed  between  kitchen 
and  dining-room,  if  possible. 


FIG.    .-J-.     -TATE    HOSPITAL,    KARLSRUHE. 
KITCHEX    DETAIL. 

It  has  been  found  in  many  institutions 
that  a  dining-room  or  restaurant  for 
friends  of  the  patients  is  not  onlv  a 
source  of  satisfaction  to  the  friends  but 
also  a  profit  to  the  hospital. 

The  feeding  of  servants  has  been  ac- 
complished in  an  economical  wav  in 
many  institutions  by  establishing  a  self- 
serve  system,  where  each  person  selects 
what  suits  him  best,  takes  it  to  the  table, 
and  eats.  This  removes  dissatisfaction 
on  the  part  of  the  ser^-ants,  facilitates 
the  service,  and  reduces  ths  number  oJ 
waiters. 


OF  THE   TWENTIETH   CENTURY 


189 


FIG.  303.    RUDOLPH-VIRCHOW   HOSPITAL.    VIEW  IX  KITCHEX. 


More  attention  is  paid  to  the  design 
and  finish  of  the  kitchens  in  many  of 
the  larger  European  hospitals  than  in 
this  country.     (Figs.  301,  302,  303.) 

Like  the  kitchen,  the  Laundry  and  Dis- 
infecting Plant  should  have  an  accessible 
location  to  which  the  soiled  linen  and 
articles  of  disinfecting  can  be  easily 
brought  and  from  which  the  fresh  linen 
can  be  removed.  The  size  and  character 
of  the  building  is,  of  course,  governed 
by  the  requirements  and  size  of  the  in- 
stitution. 

In  planning  the  hospital  laundry,  the 
same  care  and  thought  should  be  used 
as  in  planning  a  factory ;  that  is,  to 
secure  the  greatest  efficiency  m  the  work, 
from  the  bringing  in  of  the  soiled  linen 
to  the  delivery  of  the  clean.  From  the 
sorting  room  to  the  linen  room,  an  efifort 
should  be  made  to  avoid  lines  of  crossing 
and  re-crossing;  one  process  should  fol- 
low the  other  until  the  work  is  completed. 
The  washing  or  wet  work  should  be  kept 
separate  from  the  ironing  or  dry  work. 

If,  as  is  quite  common  now  in  hos- 
pitals, the  soiled  linen  is  bagged  at  the 
ward  unit,  then  easy  transportation 
should  be  provided  for  these  bags,  and  a 


covered  corridor  above  or  below  ground 
is  quite  desirable  for  this  transporta- 
tion. 

In  regard  to  the  equipment  of  the  laun- 
dry, much  may  be  said,  but  whatever 
apparatus  is  used,  the  principle  which 
has  been  set  forth  for  the  conservation 
of  human  energy  should  be  brought  into 
play  in  this  department.  For  a  single 
example  take  the  sorting  bins;  if  these 
be  placed  high  enough  so  that  it  is  not 
necessary  to  stoop  every  time  a  single 
article  is  handled  and  if  these  sorting 
bins  are  made  with  easy-rolling  wheels, 
the  transmission  of  the  soiled  linen  will 
be  secured  with  the  least  amount  of 
fatigue  on  the  part  of  the  operatoru. 

The  various  items  of  machinery 
should  be  selected  for  the  efficiency  they 
will  show.  A  washing  machine  capable 
of  doing  the  work  of  three  ordinary  ma- 
chines and  costing  the  price  of  two  is 
an  economy.  The  same  is  true  with 
reference  to  the  extractor,  the  mangle, 
the  drying  tumbler,  etc. 

Electricity  is  rapidly  taking  the  place 
of  gas  and  steam  in  many  of  the  laundry 
operations.  The  body  ironer  is  being 
superseded  by  the  steam  press. 


190 


THE  AMERICAX  HOSPITAL 


FIG.  304.    CIXCIXXATI  GENERAL  HOSPITAL.    VIEW  IX  KITCHEX,  SHOWING  FOOD  CARRIAGES. 


FIG.    305.    KITCHEX    BL^LDING— NEW    GENERAL   HOSPITAL,    CINCINNAI L    '  >nb 
Samuel  Hannaford   &   Sons,   Architects. 


OF  THE  TWENTIETH  CENTURY 

01 


191 


6 


11  J 


192 


THE  AMERICAN  HOSPITAL 


FIG.   306.    OHIO    VALLEY    GENERAL   HOSPITAL.    VIEW   IX    KITCHEN. 


FIG.    310.    MAIN    KITCHEN,    ROSS    PA\TLION-ROYAL   VICTORIA    HOSPITAL. 


OF  THE   TWENTIETH   CENTURY 


193 


FIG.   311.     SERVING    KITCHEN,    ROSS    PAVILION— ROYAL    VICT(JRIA    HOSPITAL 


FiR^T  Floor.  Vlapj 

FIG.    314.    ST.    LUKE'S    HOSPITAL,    JACKSONVILLE— LAUNDRY    BUILDING. 


194 


THE  AMERICAX  HOSPITAL 


care  of  in  the  soiled  linen  sorting  room; 
then  carried  to  the  wash  room  where 
the  wet-washing  work  is  done;  thence 
through   the   drying  room,   mangle   and 


DELIVE^lY 

^OOtA    AND 

OFFICE 


WAJH   loOM 


WA^Ht^ 


VJA6HE1L 

WA^-HEfe^ 

TfeJH 


D 


JOILED 
Linen 


Men 


fH^5T  Flool  I^lan 

,  o 8 * 

OCA.1.E.      ™    ™    ■    ^    ™    ■    M-—-I 
4.  11 

Je^vice  Building 

^HIDGEPO^T  HOJPITAL-^^IDCEPO^T   CONN 

EbWAjLt)     f.    ^TEVENi     -    Afe-CHITECT       •      &0  3TON  MAS-S. 


FIG.  312. 


In  a  large  hospital  it  is  considered  de- 
sirable to  have  the  staff  linen  laundered 
in  an  entirely  different  department  from 
the  hospital  linen. 

It  is  undoubtedly  an  economy  to  have 
the  main  linen  room  of  the  institution 
connected  directly  with  the  laundry,  from 
which  the  freshly  laundered  articles  as 
well  as  the  new  supplies  can  be  given 
out.  In  this  way,  the  linen,  whether  new 
or  old,  is  under  one  supervision. 

A  few  illustrations  will  serve  to  show 
some  of  the  points  mentioned. 

In  the  laundry  of  the  Bridgeport  Hos- 
pital (Fig  312),  the  writer  has  attempted 
to  work  out  the  principles  mentioned; 
that  is,  the  soiled  linen  is  the  first  taken 


linen  room,  into  the  main  linen  supply 
room.  Provision  for  infected  clothing, 
which  is  brought  in  through  a  separate 
entrance  and  introduced  into  the  washing 
department  of  the  laundry  through  a 
sterilizer  or  sterilizer  washer,  is  here 
provided. 

In  the  small  laundry  of  the  St.  Luke's 
Hospital  at  Jacksonville  (Fig.  314), 
where  care  of  both  general  patients  and 
contagious  cases  is  provided,  the  same 
provision  is  made  for  the  infected  linen — 
passing  through  a  disinfector  before 
reaching  the  laundry  proper. 

Fig.  315  shows  the  interior  of  the 
laundry  of  Hospital  for  Sick  Children, 
at  Toronto. 


OF  THE  TWENTIETH  CENTURY 


195 


S 

91 

y^ 

^^^^^^^^^^^^^^^^^^^^^^^^1^^^^^ . 

IK'i^ 

FIG.  315.    HOSPITAL  FOR  SICK  CHILDREN,  TORONTO.    LAUNDRY  BUILDING.    INTERIOR  VIEW, 


196 


THE  AMERICAN  HOSPITAL 


CHAPTER  XV. 


ileating,  l^entilating  anb  plumbing 


The  power  plant,  the  center  of  the  me- 
chanical end  of  the  hospital,  in  many 
respects  is  not  unlike  the  power  plant 
for  any  institution  or  manufactory.  An 
hospital  plant,  however,  is  unique  in  its 
demand  for  the  production  of  steam  in 
an  economical  way,  the  transmission  of 
the  steam  into  horsepower  energy, 
either  for  generating  electricity,  furnish- 
ing high  pressure  steam  for  laundry, 
kitchen,  or  sterilizing  room,  inasmuch  as 
steam — i.  e.  high  pressure  steam  or  its 
equivalent — is  needed  twenty-four  hours 
a  day  and  three  hundred  and  sixty-five 
days  in  the  year  for  sterilizing.  There- 
fore there  is  little  saving  made,  even  in 
a  small  plant,  by  using  low  pressure 
heating  and  using  gas  or  electricity  for 
sterilizing. 

Using   steam   for   sterilizing,   cooking. 


The  much  discussed  problem  of  how 
properly  to  heat  and  ventilate  a  hospital 
building  has  still  many  unsettled  points, 
almost  as  many  as  the  floor  problem.    It 


FIG.  320.    DIRECT-INDIRECT  RADIATOR,    SHOW- 
ING  REMOVABLE    SHIELD. 

and  laundry,  it  can  be  readily  seen  that 
the  generating  of  electricity  would  show 
a  marked  economy,  even  in  the  small  in- 
stitution, for  in  the  heating  months  the 
exhaust  steam  from  the  engines  would 
serve  for  heating  the  buildings,  reducing 
the  cost  of  current  and  heating  to  a 
minimum.  It  is  not  intended,  however. 
in  this  book  to  discuss  the  power  plant 
methods,  but  merely  the  portions  of  the 
plant  affecting  the  health  and  comfort 
of  the  patient. 


Method  °^  heating  general  Ho/pital 
At   Vienna 

FIG.    321. 

is  still  undecided  whether  it  is  best  to 
conduct  the  air  to  the  ground  floor  or 
basement,  heat  it  there,  send  it  through 
the  building  warmed,  washed  and  humid- 
ified, and  force  it  into  the  closed  room 
under  thermostatic  control  at  a  given 
temperature  night  and  day,  a  system 
which  necessitates  for  its  perfect  work- 
ing the  closing  of  all  doors  and  windows  ; 
or  whether  to  heat  the  air  by  means  of 
indirect  radiators  in  the  basement  or  pipe 
space  and  conduct  it  by  its  own  ascentive 
force  to  the  rooms  or  wards ;  or  whether 
to  use  the  simple  system  of  putting  the 
heating  units  in  the  room  and  intro- 
ducing outside  air  directly  below  or 
above  the  radiators ;  or  whether  by  direct 
hot  water,  direct  steam,  or  a  combina- 
tion of  various  systems. 

One  of  the  simplest  methods  and  one 
adopted  by  the  writer  for  securing  fresh 
warmed  air  is  a  modification  of  the 
commercial       direct-indirect       radiator. 


OF  THE   TWENTIETH   CENTURY 


197 


FIG.    322.    HEATING    CHART,    SHOWING    UNDE-_ 
SIRABLE   CONDITION    FOR    SICK    ROOM. 

(Fig.  320).  A  radiator  (hospital  type 
preferred)  is  set  on  brackets  four  inches 
above  the  floor  ;  air  is  introduced  through 
the  outside  wall  directly  in  line  with  the 
bottom  of  the  radiator.  A  shield,  hinged 
at  the  bottom  to  allow  for  cleaning  and 
extending  under  the  radiator  Joining 
the  intake  pipe,  prevents  direct  cold  air 
from  entering  the  room ;  and  a  damper 
in  the  direct  flue  governs  the  amount  of 


air.  At  the  new  General  Hospital  at 
Vienna,  out-door  air  is  introduced  di- 
rectly above  the  radiator,  as  shown  in 
Fig.  321. 

Many  medical  men  and  hospital  ex- 
perts agree  that  the  patient  in  bed,  ex- 
cept in  special  cases,  should  not  have  a 
high  temperature  in  his  room.  They 
agree  that  Nature  calls  for  changes  in 
temperature — that  the  man  in  robust 
health  demands  them ;  that  the  patient 
who  is  building  up  his  strength  should 
not  be  denied  them.  A  certain  professor 
in  a  technical  school  used  to  say  to  his 
class  that  the  ideal  temperature  is  that 
oi  .a -sunny  June,  day  in.  a -New  England 
pine  forest.     Such  an  ideal  does  not  in- 


FIG.  324. 


DETAIL  OF  VENT  FLUE  ABOVE. 
FLOOR. 


FIG.  323.  DETAIL  OF  VENT  FLUE  AT  FLOOR. 


volve  an  even  temperature  of  sixty-eight 
degrees  for  the  entire  day. 

Manufacturers  of  various  apparatuses 
pride  themselves  on  controlling  the  tem- 
perature of  a  room  to  a  fraction  of  a 
degree,  as  shown  by  chart  record  (Fig. 
322).  This  would  not  seem  to  be  con- 
ducive to  the  best  results,  excepting; 
under  certain  conditions. 

The  breathed  air  in  a  ward  or  room 
should  be  in  some  way  removed,  and 
the  means  for  ventilating  so  located  as 
tO"  insure  a  complete  circulation  of  air. 
If  the  room  is  large,  there  should  be 
vents  at  top  and  bottom,  with  dampers, 
so  that  the  air  can  be  drawn  from  either 
one  or  the  other,  by  properly  adjusting 
the  damper. 

The  vent  ducts  should  start  at  the 
floor,    and    the   floor   material    extended 


198 


THE  AMERICAN  HOSPITAL 


to  the  back  of  the  flue  (Fig.  323),  or 
the  bottom  of  the  flue  curved  so  that  no 
dust  shall  remain  in  it.  In  no  case  should 
a  register  face  be  used  to  close  the  open- 
ing at  the  floor. 

However  the  air  is  introduced,  the  ex- 
haust should  be  placed  so  as  to  vent  all 
parts  of  the  room.  If  the  air  is  intro- 
duced at  or  near  the  wind'c^w,   the  ex- 


/ection 


FIG.  325.    DETAIL  OF  VENT  THROUGH  CLOSET. 

haust  should  be  near  the  door.  The  de- 
sirability of  ventilating  the  clothes  cup- 
boards as  well  as  the  room  led  the  writer 
to  adopt  the  method  of  placing  the  room 
vent  in  the  ceiling  of  the  cupboard,  cut- 
ting the  door  thereto  so  as  to  leave  an 
open  space  below%  setting  the  cupboard 
shelf  away  from  the  wall,  and  in  this 
way  allowing  a  free  circulation  of  air, 
ventilating  the  room  and  cupboard.  ( Fig-. 
325.) 

_  The  natural  "tepee"'  form  of  ventila- 
tion is  used  in  a  number  of  Massachu- 
setts institutions — that  is,  providing  for 
heat  units  on  the  outer  walls,  either  ra- 
diators or  coils;  making  the  side  walls 
low,  about   seven   feet,  and  sloping  the 


ceiling  at  least  thirty  degrees  to  a  moni- 
tor vent.  The  result  is  ideal  heating 
and  ventilation,  but  the  difficulty  of  using 
this  method  in  large  units  is  the  neces- 
sary waste  space  involved  in  the  sloping 
ceiling  and  the  monitor,  although  this 
has  been  carried  out  in  the  Children's 
Hospital  in  Boston,  in  the  State  Hos- 
pital School  for  Crippled  Children  at 
Canton,  Mass.  (Fig.  326),  and  in  the 
children's  ward  of  the  Worcester  City 
Hospital  (Fig.  146). 

The  use  of  hot  water  for  general  heat- 
ing and  steam  for  special  ventilating 
units  gives  satisfactory  results.  The  hot 
water  may  be  in  coils  of  large  pipes,  eas- 
ily cleaned,  or  radiators  of  hospital  type 
set  away  from  the  wall ;  but  the  common 
ornamental  radiataor,  set  close  to  the 
wall,  should  never  be  used  in  the  sick 
room,  since  every  surface  should  be 
available  to  the  brush  or  vacuum  clean- 
ing pipe. 

The  heating  of  the  operating  room  at 
St.  Georg's  in  Hamburg  is  one  of  the 
more  elaborate  systems.  In  the  section 
shown  (Fig.  72),  it  will  be  observed 
that  the  outer  sash  is  double  and  the  air 
conducted  entirely  around  this  hollow 
space,  warming  in  winter  and  cooling  in 
summer  the  floor,  the  walls,  and  the  ceil- 
ings. In  winter,  additional  heat  is  se- 
cured from  direct  radiators  behind  thin 
nickel  plates  shown  in  the  walls,  but  al- 
lowing no  air  from  this  source  to  enter 
the  room.  The  air  for  the  operating 
rooms  is  brought  first  into  a  clean  cham- 
ber where  it  is  passed  through  ground 
coke,  thence  over  heated  coils  in  winter 
and  over  ice  in  summer,  into  the  fan, 
where  it  is  driven  through  a  filter  of  fine 
sand  and  gravel,  and  taken  thence  to  the 
operating  rooms,  practically  free  from 
all  bacteria.  The  ceiling  vents  in  the 
operating  rooms  are  closed  and  there  is 
sufiicient  pressure  outward  so  that  the 
opening  of  a  door  does  not  admit  any 
foul  air. 

A  simpler  method  for  the  heating  and 
supplying  of  fresh  air  for  the  operating 
room  is  by  the  use  of  a  screen  or  false 
wall  inside  the  operating  window.  The 
heating  unit  is  placed  between  the  screen 
and  the  outer  window,  introducing  out- 
door air  at  the  top  (not  the  bottom)  of 


OF  THE   TWENTIETH  CENTURY 


199 


the  radiator.  The  air  from  the  room 
drawn  under  the  screen  mingles  with 
the  outdoor  air,  is  heated,  and  passes 
out  over  the  top  of  the  screen,  warming 
the  room  by  this  inflow  and  by  direct 
radiation  from  the  glass  screen.  Ad- 
ditional radiating  surface  may  be  placed 
above  the  ceiling  lights.  To  prevent  the 
entrance  of  any  dust  from  outside,  gauze 


removable  screens  may  be  placed  in  the 
openings  at  the  top  of  the  screen.  A  sec- 
tion through  the  operating  rooms  of  the 
Ross  Pavilion  of  the  Royal  Victoria 
Hospital  (Fig.  327 j  will  serve  to  show 
this  method,  and  a  reference  to  the  illus- 
tration of  operating  rooms  at  the  Bridge- 
port Hospital  (Fig.  82 j  will  show  the 
effect  from  the  room. 


FIG.    326.    HOSPITAL    SCHOOL    AT    CANTON,    MASS.    SHOWING    ROOF    VENTILATION. 


200 


THE  AMERICAN  HOSPITAL 


\A/I  Of  OKUrm  ^OD/A  fZQTlOA  T++ILO'  OPLUmq  U.O/i  IwM 

\ioyy   ]>AviLio/J  "  Hoval  Victoilia-  Hoz-pijal 

FIG.  327. 


Additional  radiation  may  be  secured 
by  radiators  entirely  concealed  in  wall 
pockets  whose  openings  are  covered  with 
metal  plates  or  marble  slabs.  Fully  fifty 
per  cent,  of  the  radiation  is  lost  in  this 
process,  though  the  radiator  is  hidden 
effectually  and  hygienically. 

It  is  desirable  to  use   forced  ventila- 


tion in  the  operating  suite,  if  nowhere 
else.  If  the  suite  is  small,  the  fan  may 
be  placed  nearby  and  operated  when  the 
rooms  are  in  use.  Gravity  ventilation, 
ihowever,  should  be  provided,  with  a  by- 
pass valve  so  connected  with  the  switch 
and  fan  that  when  the  fan  is  stopped 
the  damper  automatically  opens    to    the 


FIG.     328.    QUINCY     CITY     HOSPITAL.    OPERAT- 
ING ROOM,   SHOWING  RADIATOR  SHIELD  AND 
CRANE  LIGHT. 


FIG.  330.    QUINCY  CITY  HOSPITAL.    SURGEONS' 
SCRUB-UP   IN   OPERATING    SECTION. 


OF  THE  TWENTIETH  CENTURY 


201 


gravity  vent,  which  itself  should  be 
accelerated  by  a  steam  coil. 

No  attempt  is  made  here  to  furnish 
data  for  the  power  plant  or  the  heating 
and  ventilation  of  the  hospital,  for  these 
should  be  worked  out  with  the  heating 
specialist;  but  these  few  suggestions  are 
offered  as  the  results  of  the  observa- 
tion of  the  writer  in  his  own  practice. 

Hospital  plumhing,  so  far  as  the  pipes, 
drains  and  vents,  and  the  so-called 
"roughing-in"  are  concerned,  is  no  dif- 
ferent from  that  for  any  other  building 
of  like  grade ;  but  the  actual  iixtures 
should  be  selected  or  designed  for  the 
purpose  for  which  they  are  to  be  used. 
Hospital  plumbing  should  be  standard- 
ized as  far  as  possible. 

Where  practicable,  fixtures  should 
stand  clear  of  the  walls  to  facilitate 
cleaning  and  to  prevent  vermin  from 
finding  a  lodging,  and  the  wall  immedi- 
ately behind  the  fixture  should  be  pro- 
tected with  tile  placed  flush  with  the  ad- 
joining plaster.  If  this  is  done,  the  ill 
effect  of  spattering  will  not  be  seri- 
ous. 

The  plumbing  trap,  in  our  modern 
times,  is  the  one  necessity  of  every 
plumbing  fixture  which  has  the  recep- 
tion and  discharge  of  liquids  into  the 
drainage  system.  It  can  readily  be  seen, 
if  the  hygienic  condition  of  our  fixtures 
be  considered,  that  this  trap  should  have 
two  possibilities — 

(a)  To    safeguard    properly    the    es- 

cape of  sewer    gas    or    sewer 
odor  into  the  room; 

(b)  To    be    so    constructed    that    the 

inside  as   well   as  the   outside, 
or   at    least   the   inside    to   the 
water  line,   shall  be  accessible 
for  frequent  cleaning. 
To  do  this  latter  readily,  the  trap  must 
be  set  close  to  the  fixture,  and  have  a  re- 
movable   strainer    for    cleaning.       Few 
medical    institutions,    even,    have    traps 
accessible   in   this   way.     And   still  how 
important    this    feature    is!      Of    course 
every    trap    should    be    vented    or    have 
some   anti-syphon   device,   but   the   local 
plumbing    law    generally     governs     this 
feature. 

Overflows  constitute  another  filthy, 
unhygienic  condition  that  exists  in  nine 


out  of  every  ten  bowls,  sinks,  or  bath- 
tubs in  general  use.  These  are  general- 
ly built  integral  with  the  china  or  iron, 
never  smooth  at  best,  and  rarely  get-at- 
able  in  any  way.  The  construction  of 
all  bowls  and  sinks  should  be  simplified 
by  the  use  of  the  celluloid  standpipe, 
which  is  light  and  easily  cleaned;  or  the 
full,  open  overflow,  with  strainer,  or 
similar  device.  In  the  double  sink,  if 
the  partition  is  a  little  lower  than  the 
sides,  one  sink  serves  as  an  overflow  for 
the  other. 

The  washing  in  running  water,  re- 
quired by  certain  religious  sects,  is 
really  the  ideal  of  cleanliness. 

The  piping  requiring  polishing  should 
be  reduced  to  a  minimum,  for  the  care 
of  brass  work  is  a  considerable  item  of 
expense  in  a  large  institution.  Where 
polished  brass  is  desired,  yellow  metal 
ishould  be  specified.  Heavily  nickel- 
plated  pipes  and  fixtures  wear  well. 
Pipes  and  fittings  finished  in  white 
enamel,  properly  applied,  are  very  satis- 
factory. The  traps  and  less  conspicuous 
parts  may  be  bronzed  or  painted,  saving 
considerable  expense. 

The  new  type  watercloset,  hung  from 
the  wall  (where  the  construction  will 
permit),  is  a  great  improvement  over 
the  old  styles,  and  is  being  used  in  many 
tinstitutions.  The  material  selected  for 
the  seat  is  important;  if  covered  with 
celluloid  or  some  other  acid-resisting 
substance  and  cut  away  in  front,  it  is 
much  more  hygienic.  The  cover,  as  a 
rule,  should  be  omitted.  The  flushing 
can  be  accomplished  either  by  a  flushing 
valve,  low-down  or  high  tank  so  long  as 
it  works  properly.  The  water  seal,  quiet 
action,  and  appearance  are  all  questions 
to  be  considered. 

The  slop  sink  in  the  work  room  is 
used  largely  for  the  emptying  and  cleans- 
ing of  bed  pans  and  urinals,  ^nd  the  fix- 
ture should  be  so  planned  that  this  can 
be  accomplished  quickly  and  easily.  To 
do  this,  the  hopper  must  have  a  large, 
unobstructed  outlet  like  that  of  the 
watercloset ;  it  should  slope  quickly  to 
the  outlet ;  means  of  cleansing  the  in- 
side must  be  provided,  either  by  a  flush- 
ing rim  or  a  short  piece  of  flexible 
hose,  or  both,  the  hose  being  the   sim- 


202 


THE  AMERICAN  HOSPITAL 


FIG.     332.    ST.     LUKE'S     HOSPITAL,     JACKSONVILLE.    ISOLATION     DEPARTMENT.    ADMITTING 
ROOM,    SHOWING   ADMITTING    BATH. 


plest  method  of  cleansing  the  inside  of 
the  utensils.  The  fixture  should  be  set 
high  enough  so  that  the  work  can  be  done 
without  stooping.  If  a  sterilizing  hop- 
per is  wanted,  secure  one  in  which 
all  the  contents  can  be  sterilized,  and 
one  which  can  be  easily  cleaned  and 
repaired. 

Many  of  the  so-called  "clinic"  hop- 
pers are  simply  a  complicated  mass  of 
valves,  pedals  and  sprays,  which  need  a 
mechanician  to  operate  and  keep  in  or- 
der. The  simpler  the  fixture  (Fig.  330), 
the  more  effectual  it  is. 

BatJi  tubs  for  patients  should  be  set 
up  from  the  floor  for  two  reasons — 
facility  of  cleaning  underneath,  and  ease 
in  bathing  if  nurse  or  attendant  needs  to 
assist.  The  inlets  should  be  large,  allow- 
ing the  full  discharge  of  hot  and  cold 
water  at  the  same  time.  The  type  of 
inlet  used  on  ocean  steamships  allows 
of  quick  filling.  The  overflow,  if  any, 
should  be  easily  cleaned ;  but  in  most 
cases,  there  is  no  need  of  an  overflow. 
A  plug  or  standpipe  and  not  a  "flow- 
back"  form  of  concealed  standpipe  should 
be  used.  The  celluloid  standpipe,  which 
is  light  and  easily  cleaned,  is  less  likely 
to   cause   damage   if   dropped. 

It  is  the  opinion  of  many  hospital  ad- 


ministrators that  the  only  way  to  be 
sure  that  a  patient  is  thoroughly  bathed 
is  to  use  some  form  of  shower  bath. 
This  may  be  a  shallow  tub  or  bathing 
slab,  set  high  but  within  easy  reach 
of  the  attendant,  the  patient  being 
washed  in  clean,  running  water  by  means 
of  a  hose  and  spray,  the  tub  or  slab  be- 
coming merely  a  drain  for  the  water.  In 
this  way  all  of  the  dirt  goes  directly  to 
the  drain  and  is  not  diluted  and  used 
again  on  the  body.  This  form  of  bath 
(Fig.  332)  should  be  used  with  entering 
patients,  particularly  in  the  contagious 
and  children's  departments.  In  many 
of  the  European  hospitals  for  women 
this  form  is  the  only  one  used.  The  same 
principle  serves  in  the  portable  tub  (Fig. 
153)  described  in  Chapter  IV.  Pro- 
vision must  be  made  in  the  plumbing, 
however,  where  this  form  is  used,  for  a 
suitable  floor  drain  and  a  hose  connec- 
tion to  the  room  fixture. 

The  principle  of  the  high,  shallow 
tub  or  slab  is  quite  generally  used  in 
bathing  children  (Fig.  333)  and  infants. 
In  both  cases  some  reliable  temperature- 
controlling  device  should  be  placed  on 
the  supply  or  a  separate  storage  tank 
placed  directly  above  the  bathing  slab. 
This   tank    should   have   a    visible   ther- 


OF  THE  TWENTIETH   CENTURY 


203 


mometer  and  water  gauge.  The  use  of 
the  spray  can  be  facilitated  where  there 
is  a  storage  tank  by  using  a  self-closing 
spray  head. 

The  infants'  bath  is  naturally  smaller 
than  the  children's,  and  the  slab  may  be 
heated  by  admitting  hot  water  to  the 
closed  space  in  the  porcelain  directly 
under  the  slab. 

The  wash  bozd  or  lavatory  now  placed 
without  restraint  in  the  patients'  rooms 
and  the  open  corridor,  as  well  as  in  the 


FIG.    333.     BABY    BATH. 

toilets  and  wash  rooms,  should  be  de- 
signed on  the  same  simple  lines  suggested 
for  other  fixtures.  The  non-concealed 
overflow,  the  removable  strainer,  and 
the  high  trap,  all  are  desirable  features ; 
in  fact,  in  nine  cases  out  of  ten  the  stop- 
per can  be  eliminated  if  a  combination 
faucet  is  used ;  for,  once  accustomed  to 
washing  under  running  water,  the  filled 
bowl  and  washing  in  dirty  water  will 
be  abandoned. 

For  ward  bowls,  bowls  iv  corridor, 
and  bowls  for  scrubbing  up  for  dress- 
ings, the  wrist  or  elbow  mixing-valve 
may  be  used  to  advantage  (Fig.  634). 


FIG.   334.    TYPICAL  LAVATORY   FOR   PATIENT'S 
ROOM. 

Where  it  is  desirable  to  fill  the  bowl, 
a  standpipe  of  celluloid,  made  to  fit  the 
opening,  gives  an  easily  cleaned  overflow. 

The  scrub-up  for  the  surgeon,  as  a 
l^reparation  fur  operation,  has  under- 
gone various  changes :  from  the  foot 
valve,  good  at  times  but  depending  on  an 
even-pressure  of  the  foot  of  the  surgeon 
to  produce  an  even  flow  of  an  even  tem- 
])erature ;  then  various  forms  of  the 
knee   valve,    dependent    upon    a    mixing 


FIG. 


336.    OHIO    VALLEY    GENERAL   HOSPITAL. 
SURGEONS'    SCRUB-UP. 


204 


THE  AMERICAN  HOSPITAL 


valve  for  the  temperature,  without  regu- 
lation of  flow;  up  to  the  simpler  elbo^v 
or  forearm  control.  Again  we  find 
that  the  work  of  the  European  special- 
ists has  given  us  models  from  which  to 
work.  A  page  from  a  Swiss  plumbing 
catalogue  (Fig.  335)  shows  a  variety 
of  simple  forms  of  both  foot  and  elbow 
action  valves. 

For  the  scrub-up  for  a  number  of 
surgeons,  the  long  sink  with  several  sets 
of  outlets  has  proved  satisfactory.  Single 
bowls,  set  together  on  one  central 
screen,  as  at  the  Ohio  Valley  General 
Hospital  (Fig.  336)  or  the  Youngstown 
Hospital,  allows  of  easy  access.  In  the 
smaller  hospital  this  same  idea  may  be 
carried  out  wath  a  raised  basin  in  the  cen- 
ter of  the  operating  rotunda,  as  at  the 
Charles  Choate  Memorial  Hospital  (Fig. 
337)  ;  for,  with  the  combination  non- 
hand-touching  valve,  all  that  is  needed  is 
sufficient  spillway  for  the  water.      This 


form  of  scrub-up  valve  placed  over  the 
w^ork-room  sink  gives  an  additional  place 
for  washing.  It  may  be  placed  over  a 
simpler  sink  in  infectious  wards,  allow- 
ing for  the  special  cleansing  of  the 
nurse's  hands  and  the  giving  of  the  baths 
an  the  portable  tubs  (Fig.  338).  (See 
Chapter  VII.) 

The  floor  drain,  highly  important  in 
certain  sections,  may  be  a  menace  to 
health  unless  properly  constructed  and 
kept  filled  with  water.  For  operating 
and  autopsy  rooms  a  flushing  rim  trap 
is  desirable.  This  top  should  be  solid, 
to  resist  the  movement  of  heavy  fur- 
niture   (Fig.  339). 

The  autopsy  table  is  generally  made  a 
part  of  the  plumbing,  and  a  simple  fix- 
ture which  has  proved  satisfactory  is 
shown  herewith  (Figs.  340  and  341). 
The  center  is  the  highest  part,  allowing 
the  fluids  to  flow  away  from  rather  than 
toward  it.     A  small  sink,  made  integral, 


FIG.    335.    A    PAGE    FROM    A   SWISS    PLUMBING    CATALOGUE. 


OF   THE   TWENTIETH   CEXTURY 


205 


FIG.  338.    SINK  FOR  ISOLATION  WARDS,  SHOW 
IXG    Lx^BOW   VALVE   AXD   FLOOR  DRAIX. 


FIG.     337.    CHOATE     MEMORIAL     HOSPITAL. 

SCRUB-UP    SINK. 

Edward    F.    Stevens,    Architect. 


PLftN 


yii,/„/«iu,j      iMrnt. 


^ —  Cajt  Covtt 


FIG.    340.    AUTOPSY    TABLE,    SHOWING    DRAIN 
TOWARD    OUTSIDE    OF    FIXTURE. 


Uj-Clean  Out 
f  LOO^  DEMN 

FIG.    339. 


206 


THE  AMERICAN  HOSPITAL 


FIG.     342.    "BUBBLING"     DRINKING     FOUNTAIN 
FOR  HOSPITAL  CORRIDORS. 


FIG.    343.     MEDICINE    CLOSET. 


FIG.   34L    MARBLE  AUTOPSY  TABLE,   WITH   SINK   ATTACHED. 


OF   THE   TWENTIETH   CENTURY 


207 


is  provided.  A  simple  means  of  flush- 
ing is  obtained  by  using  a  flexible  hose 
pipe,  into  which  a  copper  wire  is  in- 
serted. By  means  of  this  the  end  of 
the  hose  may  be  made  to  remain  in 
whatever  position  it  is  placed,  allowing 
the  flushing  action  to  go  on  without 
interruption. 

The  drinking  zvater  problem  of  the 
hospital  has  been  solved  in  various  ways 
by  various  hospital  men.  There  should 
be  a  goodly  supply  of  pure  water  easily 


procurable  for  the  patient,  for  the  nurse, 
for  everybody. 

The  system  used  by  the  writer  at  the 
Ohio  Valley  General  Hospital  and  at  the 
Royal  Victoria  Hospital  is  to  distill  all 
the  water  for  drinking  and  clinical  pur- 
poses. On  each  floor,  outlets  were  pro- 
vided where  the  water  is  cooled,  install- 
ing a  fountain  for  patients'  use  (Fig. 
342).  This  fountain  is  provided  with 
an  outlet  for  drawing  water  into  a  re- 
ceptacle as  well. 


208 


THE  AMERICAN  HOSPITAL 


CHAPTER  XVI. 


BetailsJ  of  Construction  anb  Jfinisif) 


The  exterior  details  of  the  hospital 
should  be  made  to  conform  to  the  style 
of  architecture  in  which  the  building  is 
designed  and  should  be  left  to  the  archi- 
tect, it  being  borne  in  mind  that  the  detail 
and  exterior  treatment  should  be  sub- 
servient to  the  plan;  in  other  words,  the 
exterior  should  be  designed  around  the 
plan,  and  not  the  plan  made  to  suit  the 
elevation  as  is  so  often  the  case.  Economy 
in  construction  can  be  realized  by  es- 
tablishing units  in  the  ])lanning,  by  hav- 
ing the  partitions  continuous  and  the 
plumbing  of  one  story  near  that  of  the 
others. 

The  interior  finish,  especially  in  the 
patients'  rooms,  should  be  carefully 
studied  from  the  economic  and  hygienic 
sides.  Projecting  surfaces  are  difticult 
to  keep  clean  and  should  be  eliminated 
as  far  as  possible.  If  the  door  jambs 
are  made  of  steel  pressed  to  a  suitable 
form,  with  angles  rounded,  and  are  set 
to  form  a  ground  for  the  plasterer,  there 
will  be  no  projection.  To  avoid  the  usual 
sharp  angle  at  the  junction  of  the  door 
jamb  and  the  floor,  the  door  stop  should 
be  omitted  for  a  few  inches  above  the 
floor  and  the  coved  base  allowed  to  run 
through  the  jamb  fFig.  350).  If  the 
door  jamb  is  of  wood,  the  same  general 
detail  can  be  used ;  and  to  protect  against 
the  slight  sinkage  of  plaster,  a  small  oval 
wood  or  metal  strip  can  be  used.  Tran- 
soms, where  used,  may  be  the  thickness 
of  the  door,  and  the  usual  projection 
avoided. 

The  base  around  the  rooms  can  be 
made  of  the  floor  material  or  of  tile, 
marble,  metal,  wood,  or  any  enduring 
material,  depending  on  the  appropriation 
and  the  individual  preference;  but  if 
coved  at  the  juncture  of  wall  with  floor, 
made  flush  with  the  wall  line,  and  carried 
through  the  door  jamb  of  the  same  ma- 
terial,   the    hygienic    qualities    are    en- 


hanced. To  prevent  the  furniture  from 
marring  the  walls,  a  furniture  shoe 
formed  in  the  base,  three  or  four  inches 
from  the  wall,  can  be  used  to  advantage. 
Bases  and  door  jambs  of  this  type  are  set 
before  plastering,  so  that  ever}^  part  of 
the  finish  is  smooth  with  the  wall. 

JVindoii's  should  be  placed  low  enough 
so  that  a  patient  in  bed  can  readily  see 
out  upon  the  street.  The  same  character 
of  finish  should  be  applied  to  windows 
as  to  doors.  It  has  been  found  that  the 
direct  draught  from  a  slightly  opened 
window  may  be  diverted  if  a  deflector 
is  placed  in  front  of  the  opening.  This 
can  be  formed  in  the  window  frame  and 
so  become  permanent  (Fig.  351). 

All  angles,  whether  wall,  floor  or 
ceiling,  should  be  coved. 

Doors  should  be  smooth,  without 
moulding.  The  no-panel  slab  doors  are 
desirable ;  or  if  these  prove  too  expen- 
sive, the  one  panel,  or  at  most  two-panel, 
door  can  be  used. 

JJ^alls  back  of  all  plumbing  fixtures 
should  be  tiled,  with  the  tile  on  the  same 
surface  and  even  with  the  plaster.  The 
walls  of  toilets,  sink  rooms,  serving  kitch- 
ens, laboratories,  and  similar  rooms 
subject  to  much  use,  should  if  possible 
be  tiled  to  a  height  of  five  feet  or  more. 

Medicine  closets  for  each  unit  (Fig. 
352 j,  built  into  the  wall,  should  have  no 
re-entering  angle.  They  should  have  a 
small  sink,  with  hot  and  cold  water,  and 
slab,  with  tiling  at  the  back,  shelves  of 
plate  glass  or  metal,  artificial  lights, 
towel  rack,  etc.  If  the  unit  is  small,  a 
built-in  medicine  closet  at  or  near  the 
corridor  bowl  can  be  substituted  (Fig. 
343). 

The  clothes  closets  for  private  rooms 
or  wards  (Fig.  325)  should  be  built  like 
the  medicine  closets.  If  the  closet  door 
is  cut  two  inches  short  at  the  bottom,  the 
vent  for  the  room  may  be  olaced  in  the 


OF   THE   TWENTIETH   CENTURY 


209 


closet  ceiling,  and  the  ventilation  of  both 
room  and  closet  accomplished.  (See 
chapter  XV  on  heating  and  ventilating.) 

Fixed  equipment  such  as  linen  closets, 
kitchen  cabinets,  etc.,  should  be  con- 
structed so  as  to  leave  a  free  space  be- 
hind them.  The  linen  closets  should  have 
open  shelves  or  racks,  so  built  that  they 
are  removable  for  cleaning;  if  the  top 
is  sloped,  the  minimum  amount  of  dust 
is  accumulated. 

Hardzvare  is  a  small  but  x&vy  impor- 
tant item,  and  should  be  carefully  select- 
ed with  an  eye  to  its  suitability  for  hos- 
pital purposes.  Unsuitable,  noisy  hard- 
ware has  been   the  cause   of  more   dis- 


turbance to  patients  in  an  institution  than 
almost  any  other  item  in  the  construc- 
tion. How  often  one  sees  the  latches 
"muzzled"  with  a  towel  or  special  pad 
which  slips  around  the  knobs,  or  covered 
weights  placed  behind  the  door  to  pre- 
vent slamming.  Hardware  suitable  for 
a  dwelling,  an  office  building,  or  a  the- 
atre is  not  suitable  for  a  hospital. 

How  often  the  nurse,  with  both  hands 
full,  is  annoyed  and  delayed  in  opening 
the  door  with  the  round  knob  !  And  how 
often  the  closing  of  the  same  door 
awakens  or  annoys  the  patient ! 

The  opening  of  the  door  with  both 
hands  full  can  be  accomplished  with  the 


^^^sStf^--^^^ 


^ax 


tllMGt  JA^Vb 
TR/iKiD  Vl  DqQDLE  OV.'JNQ  b"'^:) 

■  ■  DLTAIL!)  TYPJCAL 


fLftNaCfOTING  ATLliNCAfr      tp"-'^..  i=  stiver.    ,^ 
NcTL.  Xt^miz  To  Dt  W  \o  Cd/vr-t  Stlcl        ^^ 


FIG.  350. 


210 


THE  AMERICAN  HOSPITAL 


OF   THE   TWENTIETH  CENTURY 


211 


FIG.    353.    LINEN    CLOSET    DETAIL. 

angle  door  handle,  and  this  is  a  good 
device  where  noise  does  not  enter  into 
the  problem,  as  in  service  buildings ; 
however,  in  psychopathic  wards  the 
handle  should  have  no  shank  and  should 
be  turned  down  instead  of  up. 

With  an  efficient  checking  spring  and 
noiseless  door  holder,  the  latch  bolt  can 
be  eliminated,  and  with  it  much  of  the 
noise  from  hardware ;  then,  with  the 
reversed  hook  handle  (Fig.  355)  placed 
on  the  inside  of  the  door,  one  can  open 
the  door,  with  both  hands  filled,  by 
slipping  the  forearm  under  the  hook 
handle;  and  of  course,  with  the  latch 
eliminated,  the  door  can  be  readily 
pushed  open  from  the  outside.  For  the 
occasional  locking  of  the  door,  a  dead 
bolt  can  be  installed. 

The  hardware  for  the  elevator  doors 
should  always  run  smoothly  and  afford 
protection  against  opening  of  doors  when 
car  is  away  from  landing,  but  the  silent 
feature  should  be  emphasized  in  select- 
ing this  hardware. 

With  reference  to  floors,  the  persist- 
ent question  "What  is  the  best  floor" 
is  hard  to  answer.  Among  the  leading 
architects  and  hospital  men  in  Europe, 
the  writer  found  the  almost  universal 
preference  to  be  for  tile,  usually  a  light 
gray   flint   or  vitreous   tile,   as   large   as 


four  inches,  laid  with  a  fine  joint  and 
against  a  coved  base  of  the  same  ma- 
terial. In  America,  with  every  avail- 
able material  and  numerous  advocates 
of  each,  it  becomes  almost  a  case  of  in- 
dividual preference.  There  are  certain 
underlying  principles,  however,  which 
should  be  considered: 

(a)  Fitness  for  location. 

(b)  Durability. 

(c)  Artistic  eft'ect. 

The  patients'  room  should  have  some 
resilient  material,  quiet  in  color  and 
reasonably  non-absorbent ;  resiliency 
and  durability  should  be  considered  for 
the  corridor;  and  durability  and  non- 
absorbent  qualities  for  the  utilities. 

Good  results  may  be  obtained  with 
hardwood  floors  and  perhaps  they  are  as 
popular  today  as  any  other  floor.  With 
the  fireproof  buildings,  however,  the  de- 
mand is  for  a  floor  of  fireproof  material. 

Of  the  monolithic  floors,  terrazzo 
gives  perhaps  as  good  results  as  any  sim- 
ple, inexpensive  floor;  two  colors  may 
be  used,  one  for  the  base  and  border  and 


FIG.    354.    KITCHEN    CABINET. 


212 


THE  AMERICAN  HOSPITAL 


FIG.    355.    DETAIL    OF    HOOK    HANDLE    FOR 
DOORS. 

one  for  the  field,  with  a  dividing  line 
between  of  single  marble  tessarae.  Some 
of  the  magnesite  floors  are  giving  good 
results,  when  properly  laid.  This  can  be 
put  down  in  contrasting  colors  and  the 
artistic  effect  is  pleasing.  Under  cer- 
tain conditions — for  example,  when  laid 
in'  kitchens  and  toilets,  where  very  hot 
water  may  be  spilled — this  material  is 
apt  to  disintegrate  and  to  spot  badly. 

Quarry  tile  makes  a  good  wearing 
floor  for  the  service  part  of  the  hospital 
and  for  roof  wards  and  airing  balconies, 
and  is  artistic  as  well. 

Where  strict  economy  must  be  prac- 
ticed, a  good  quality  of  cement  floor, 
properly  treated  to  prevent  dusting, 
serves  its  purpose  well. 

x\ll  the  asphalt  floors  should  be  avoid- 
ed excepting  for  special  places  hke  por- 
tions of  laboratories,  refrigerators,  etc., 
where  an  acid-proof  floor  is  required. 

Hard,  fine-grained  marble  makes  a 
most  excellent  operating  room  floor. 
Opalescent  glass  has  been  used  more  or 
less  successfully  for  the  same  purpose. 

For  corridor  floors,  where  there  is 
much  traffic,  probably  the  best  material 
is  pressed  cork  tile.  This  is  quiet,  re- 
silient, and  wears  well.  Cork  tiling  and 
rubber  tiling  have  been  used  in  toilets 
and  baths,  but  they  possess  little  ad- 
vantage over  terrazzo  or  magnesite. 

For  wards  and  private  rooms,  wood 
floors  are  cheap  and  look  well,  but  are 


open  to  many  objections.  They  shrink 
and  swell,  have  many  cracks  to  gather 
dust,  and  need  constant  refinishing. 
Maple  is  undoubtedly  the  best  wood  floor 
material  for  a  hospital. 

Almost  everywhere  in  Europe  lino- 
leum is  used  for  the  floors  of  patients' 
rooms  and  wards,  and  its  use  is  growing 
in  favor  in  this  country.  It  can  be  used 
not  only  for  floors,  but  for  stair  treads, 
table  tops,  screens,  and  even  for  door 
panels.  When  properly  laid,  it  is  doubt- 
less the  most  satisfactory  material  which 
can  be  found.  Great  care  must  be  taken 
to  have  the  floor  underneath  smooth  and 
dry,  and  the  material  must  be  thoroughly 
stretched  and  laid  upon  the  floor  for  sev- 
eral days  before  being  fastened  down, 
then  cemented  to  the  construction,  the 
cement  being  applied  to  the  entire  under 
surface.  If  the  newer  colors  and  pat- 
terns of  linoleum  are  used,  the  effect  is 
very  pleasing. 

Too  much  care  cannot  be  taken  in  the 
planning  and  arrangement  of  artificial 
illumination,  especially  for  the  rooms  oc- 
cupied by  patients.  The  eye,  at  all  times 
a  delicate  organ,  becomes  more  sensitive 
in  sickness.     Beds  should  be  so  placed  as 


OlTA\  TUKJ    t^LftJ-J- 


u.  yV/iycit 


FIG.  356.  DETAIL  OF  WARD  LIGHTING  FIXTURE. 


OF  THE  TWENTIETH   CENTURY 


213 


to  shield  the  patients'  eyes  in  the  day- 
time, which  means  that  they  should  not 
face  the  windows.  In  open  wards,  this 
is  avoided  by  the  use  of  cross  screens,  as 
shown  in  the  Bridgeport  Hospital  (Fig. 
44)  and  in  St.  Luke's  Hospital  (Fig. 
116).  For  night  lighting,  direct  ceiling 
lights  should  be  avoided ;  instead,  re- 
flected or  obscured  lights  should  be  used, 
which  give  a  soft  glow  over  the  whole 
room,  with  no  bright  spots  These  ceiling 
lights  can  have  lamps  for  greater  or  less 
illumination  in  the  same  fixtures ;  and 
with  the  low  candle  powder  lamps  used  for 
night  service,  the  lamps  can  be  rendered 
less  disturbing  to  the  patient  by  dip- 
ping in  blue  stain.  The  fixture  placed 
near  the  ceiling,  w4th  an  opaque  or  opa- 
lescent reflecting  globe  placed  below  the 
light,  directs  all  the  rays  to  the  ceiHng, 
and  thence  difiruses  them  through  the 
room.  The  bowl-shaped  fixture  should 
be  covered  with  a  tightly  fitting  sloping 
glass  top  to  keep  out  the  dust  and  to  allow 
of  its  easy  removal  (Fig.  356).  A  most 
attractive  fixture  is  made  by  having  the 
lower  globe  double,  and  interposing 
fabric  similar  in  coloring  to  the  curtains 
and  covering  of  furniture  (Fig.  357). 

In  addition  to  the  ward  or  room  light- 
ing, there  should  be  a  wall  outlet  at  each 
bed,  where  a  portable  table  or  wall  lamp 
can  be  attached  (Fig.  358).  The  wall 
outlet  may  be  used  also  for  current  for 
an  electric  fan,  electric  heating  pad,  etc. 

The  artificial  illumination  of  operat- 
ing rooms  needs  most  careful  study. 
Rooms  have  been  sucessfully  lighted  by 
rows  of  lights  around  the  outer  wall  or 
on  the  ceiling  near  the  wall ;  by  a  more 
concentrated  light  in  the  center  with  a 
bowl-shaped  reflector ;  or  by  a  fixture 
with  several  arms  wide  apart,  so  placed 
as  to  overcome  shadows.  A  large  fix- 
ture over  the  operating  table  is  to  be 
avoided  on  account  of  its  tendency  to 
catch  and  distribute  dust;  and  if  a  cen- 
tral light  is  used,  the  swinging  crane  is 
to  be  preferred.  This  can  be  raised  or 
lowered  at  will,  or  swung  entirely  out 
of  the  way  when  not  in  use  (Fig.  89). 

Concentrated  light  from  powerful  re- 
flectors placed  above  the  ceiling  light 
gives  very  satisfactory  results.  (See 
Fig.  327.) 


J''^\At^  J^'-^T 


W+LL  ?L^yi 


FIG.     358.    PORTABLE     BEDSIDE     LAMP. 

It  is  well  to  provide  gas  for  an  emer- 
gency light  in  the  operating  room.  The 
enclosed  drop  mantle  burner  is  satis- 
factory for  the  purpose.  Emergency 
lights  have  been  successfully  made  by 
the  use  of  the  Prest-o-lite  tank,  mounted 
on  a  portable  tripod  and  surmounted  by 
a  reflecting  lamp  (Fig.  89). 

A  goodly  supply  of  hand  electric 
torches  should  be  kept  at  the  nurses'  sta- 
tions against  need. 

The  Tungsten  or  Mazda  lamp  facih- 
tates  illumination,  giving  the  maximum 
amount  of  light  with  a  minimum  amount 
of  current. 

For  lights  in  the  offices,  kitchens,  etc., 
nothing  special  is  needed,  except  to  se- 
cure a  fixture  which  has  simple  lines  and 
from  which  all  dust-catching  ornamenta- 
tion is  omitted  and  which  will  give 
proper  illumination. 

The  therapeutic  effect  of  the  color  of 
zualls,  ceilings,  and  finish  is  very  marked 
upon  patients.  There  is.  perhaps,  no  one 
thing  in  the  details  of  a  hospital  which 
should  have  more  study  than  the  wall 
and  ceiHng  decoration  or  color,  not  only 
of  the  patients'  rooms  but  also  the  en- 
trance, the   reception  rooms,  the  sitting 


214 


THE  AMERICAN  HOSPITAL 


room,  and  even  the  kitchens  and  work 
rooms.  Why  should  the  patient  of  re- 
fined taste,  accustomed  to  harmonious 
colors  in  furniture  and  walls  at  home, 
be  subjected  to  ugly,  inartistic  hospital 
rooms  ?  The  walls  should  be  of  cheerful 
colors ;  the  decorations,  if  any,  should  be 
refined.  It  is  well  to  have  diversity  of 
coloring  both  in  the  walls  and  equipment. 
If  the  walls  are  painted  a  reasonably  dark 
color  to  a  height  of  five  or  six  feet,  and 
the  ceihng  color  brought  down  to  meet 
this  line,  divided  by  a  band  or  simple 
stencil  design,  the  effect  is  very  satisfac- 
tory. If  Ahe  color  design  is  carried 
around  the  door  and  window  frames, 
making  an  artistic  flat  decoration,  so 
much  the  better. 

The  introduction  of  tile  and  mosaic  ai 
the  back  of  plumbing  fixtures  and  radi- 
ators gives  a  touch  of  color  and  in  a^d- 
dition  an  element  of  cleanHness.  (See 
Fig.  49.) 

The  walls  of  the  children's  ward  may 
be  made  most  entertaining  for  the  little 
folks  by  using  simple  decorations  of 
"Mother  Goose"  or  "farmyard"  pictures, 
pasted  on  the  walls  in  the  form  of  a 
frieze  and  made  permanent  by  a  coat  of 
varnish ;  or  prints  of  larger  pictures  may 
be  fastened  to  the  wall  in  th-^  same  way ; 
or,  as  mentioned  in  the  chapter  on  chil- 
dren's hospitals,  the  walls  may  be  deco- 
rated with  Ceramic  wall  tile. 

The  day  of  white  walls  for  operating 
rooms  or  any  other  rooms,  let  us  hope, 
is  past.  The  walls  of  the  operating  room, 
if  of  tile  or  marble,  should  not  be  white 
but  of  some  tone  which  will  not  absorb 
too  much  light  but  dark  enough  to  pre- 
vent eye  strain  on  the  part  of  the  sur- 
geon and  attendants.  If  the  walls  are 
painted,  the  same  argument  will  hold 
good. 

Many  surgeons  today  wish  the  floors 
and  lower  portion  of  their  operating 
room  a  very  dark  green,  and  use  dark 
gowns  for  themselves  and  attendants, 
for  the  same  reason — to  prevent  eye 
strain  and  to  allow  a  better  concentration 
on  the  subject  to  be  operated  upon. 

With  reference  to  nurses'  calls,  too 
much  cannot  be  said  in  favor  of  doing 
away  with  the  noisy  system  of  electric 
bells.  There  are  many  systems  of  the  so- 


called  "silent  cah"  on  the  market.  All  of 
them  have  merit.  There  are,  however, 
essential  points  which  should  be  con- 
sidered in  selecting  a  system  : 

1.  The  system  should  be  simple 
and  as  nearly  "fool-proof"  as  pos- 
sible. 

2.  The  part  made  accessible  to  the 
patient  should  be  of  non-metallic  sub- 
stance, with  smooth  lines,  non-detach- 
able and  easy  to  operate. 

3.  The  attachment  to  the  wall 
should  be  of  such  a  nature  that  if  the 
connecting  cable  should  be  held  by  the 
bed-post  and  the  bed  suddenly  moved, 
the  entire  system  will  not  be  disar- 
ranged;  in  other  words,  the  "plug"  to 
which  the  cord  is  attached  should  be 
readily  removable,  whether  a  straight 
or  a  side  pull  is  exerted.  This  is  a 
most  important  feature. 

4.  The  resetting  station  should  be 
within  easy  reach  of  the  patient's  bed ; 
if  on  the  wall,  at  such  a  height  and 
location  that  the  nurse  can  reset  it 
without  taking  the  time  to  go  around 
the  bed ;  if  at  the  press-button  itself, 
which  is  in  the  patient's  hand,  so  much 
the  better ;  but  if  the  point  of  resetting 
is  at  the  patient's  hand,  there  should 
be  some  locking  device  so  that  the 
patient  cannot  easily  cancel  her  own 
call. 

5.  The  signal  lights,  if  in  a  ward, 
should  be  shown  over  each  bed,  also 
at  the  entrance  of  the  w^ard,  at  the 
nurses'  station  and  at  the  grand  an- 
nunciator in  the  superintendent  of 
nurses'  office.  Together  Avith  the  last 
mentioned,  an  elapsed  time  record  can 
be  kept,  showing  the  time  between  any 
call  and  its  cancellation.  This  is  a  de- 
vice which  always  settles  a  dispute  as 
to  whether  a  call  remained  unanswered 
one  minute  (as  the  record  might 
show)  or  ten  fas  the  patient  might 
claim). 

A  similar  system  may  be  installed  for 
calling  internes.  The  call  is  sent  in  from 
the  main  office  and  is  flashed  to  different 
locations  in  the  hospital.  The  interne, 
seeing  his  color  or  number  illumined, 
calls  the  office  from  the  nearest  phone 
and  gets  his  instructions.     Signal  lights 


OF  THE   TWENTIETH   CEXTURY 


215 


FIG.     359.     WALL     CPIARTCASE. 

for  special  calls,  indicating  special  serv- 
ice, can  also  be  arranged. 

The  loud-speaking  telephone,  with  a 
sounder  at  convenient  locations  through- 
out the  institutions,  is  now  used  to  good 
advantage  for  calling  superintendent  or 
doctors. 

Vacuum  cleaners,  it  is  the  prevailing 
opinion,  should  be  provided  for  every 
hospital  of  fifty  beds  or  over,  where 
power  is  available.  The  piping  through 
the  buildings  can  be  very  easily  installed. 
There  should  be  a  sufficient  numb^  of 
outlets  to  make  the  w^ork  easy  of  accom- 
plishment by  the  attendants,  no  point  in 
any  room  being  more  than  fifty  feet 
from  an  outlet.  Each  outlet  should  be 
valved,  so  that  the  applying  of  the  hose 
can  be  done  with  as  little  noise  as  pos- 
sible. To  that  end,  a  special  construc- 
tion is  desirable,  making  it  possible  to 
enter  the  hose  before  opening  the  valve. 
thus  eliminating  much  of  the  noise. 

There  is  some  question  about  nurses' 
stations.  Just  where  that  of  the  head 
nurse  of  the  floor  or  section  should  be  is 
a  question  about  which  there  is  much 
discussion  among  hospital  administra- 
tors— whether  in  a  room  adjoining  the 
ward,  in  the  open  corridor,  at  a  semi- 
glazed  observation  station,  or  in  the 
ward  proper.  Dr.  Rowe,  the  late  dean  of 
hospital  superintendents,  used  to  sav 
that  he  believed  the  nurse  on  duty  should 
be  in  sight  of  her  patients  as  well  as 
within  hearing.  In  large  wards  the  cen- 
ter-of-the-ward  station  may  \\''ork  out 
wath  the  best  results. 

'\^'herever  this  station  mav  be,  certain 


conditions  and  equipment  should  exist. 
The  nurse  should  have  a  table  or  desk, 
w^ith  sufficient  light  for  her  work  of 
charting  and  keeping  her  records.  She 
should  have  facilities  for  writing  her 
records  and  holding  them  after  they  are 
written.  At  this  point,  the  nurses'  call 
system  should  have  its  annunciator. 

The  writer  believes  that  the  charts, 
notes  and  standing  orders  for  each 
patient  should  be  kept  together  and  that, 
as  far  as  possible,  those  sheets  should  be 
of  uniform  size. 

The  writer  has  found  the  most  suit- 
able chart-holder  to  be  made  of  heavy 
manilla  paper,  with  the  tops  folded  so 
as  to  enclose  the  top  ends  of  all  the  pa- 
pers, all  held  in  place  JDy  regular  ring 
paper  clips.  If  the  charts  are  to  be 
hung,  each  chart  is  punched  in  the  right 
spot  for  hanging :  if  placed  on  shelves, 
the  punching  is  not  necessary.  These 
chart-holders  are  light,  serviceable,  and 
noiseless.  A  nurse,  in  going  through  the 
wards  with  the  doctor,  can  take  in  her 
hands  the  charts  for  the  whole  ward, 
having  them  ready  as  the  patient  is  ap- 


FIG.    360.     REVOLVLVG    CHARTCASE. 


216 


THE  AMERICAN  HOSPITAL 


proached.  In  this  way  they  are  always 
kept  away  from  the  patient,  whereas  if 
the  chart  is  left  on  the  bed  it  is  available 
to  the  inquiring  mind  of  the  visitor  and 
of  the  patient  himself. 


FIG.    361.    PLAN    OF     NURSES'     STATION. 

Various  methods  for  holding  the  charts 
in  readiness  for  inspection  are  employed 
— one,  the  chart-case  opening  like  a  book 


with  one  cover  against  the  wall,  which, 
when  open,  discloses  all  the  charts  to 
view  at  one  time  (Fig.  359)  ;  another, 
the  desk  with  "pigeonholes"  for  each 
chart-holder ;  a  third,  adopted  by  the 
writer  for  use  where  there  are  a  large 
number  on  one  service,  built  on  the  prin- 
ciple of  revolving  book-case,  with  the 
center  of  the  case  placed  on  a  level  with 
the  nurse's  desk,  so  that  without  rising 
the  nurse  can  reach  any  chart  (Fig.  360). 
Where  a  room  for  the  nurses  can  be 
provided,  this  should  be  central.  The 
station  shown  (Fig.  361)  illustrates  an 
ideal  nurse's  station,  for  from  this  sta- 
tion the  nurse  controls  not  only  the  cor- 
ridor, but  the  stair  hall,  the  elevator,  the 
patients'  airing  balcony  and  the  serving 
kitchen  entrance ;  with  the  use  of  the 
telephone,  she  is  in  touch  with  all  de- 
partments. 


OF   THE   TWENTIETH   CENTURY 


217 


CHAPTER  XVII. 


(Equipment 


The  question  of  hospital  equipment  is 
fraught  with  nearly  as  many  perplexities 
as  the  planning  of  the  buildings.  The 
question  of  the  best  bed,  the  best  food 
wagon,  the  best  operating  table,  or  the 
best  wheel  stretcher  is  constantly  met. 
There  seems  to  be  no  general  rule  which 
will  apply  except  this,  that  the  simpler 
the  lines  of  the  apparatus  or  article  which 
will  accomplish  the  purpose  with  the 
greater  conservation  of  energy  of  those 
using  it,  the  better  the  equipment. 

The  ordinary  dealer  in  hospital  equip- 
ment tries  to  sell  the  wares  which  he  has 
in  stock,  and  is  not  anxious  to  have 
special  designs  ordered ;  but  many  times, 
in  order  to  get  the  best  results,  it  is  neces- 
sary to  have  equipment  specially  made. 
It  is  true  that  the  greater  part  of  the 
equipment  can  be  standardized,  but  it  is 
equally  true  that  much  improvement  re- 
mains to  be  made  in  some  of  the  present 
standards. 

Discussion  of  ec[uipment  may  properly 
consider  first  the  furniture  of  the  patient's 
own  room,  beginning  with  the  bed. 
This  must  first  of  all  be  comfortable 
for  the  patient;  it  must  be  of  the  right 
height  to  make  work  easy  for  the  nurse; 
it  should  have  extension  legs  to  allow  of 
being  raised  at  either  end  without  blocks ; 
it  must  be  easy  to  move,  yet  stationary 
when  required ;  it  should  have  an  adjust- 
able back  rest,  a  bar  at  the  foot  to  take 
care  of  the  extension  in  leg  fractures,  a 
detachable  irrigator  stafif,  and  crosswise 
bars  at  the  head  whereby  the  patient  may 
lift  himself  or  get  mild  exercise.  Full 
Gatch  or  Fowler  position  frames,  built 
into  the  bed,  can  be  used  to  great  ad- 
vantage. 

To  facilitate  moving  the  bed,  various 
forms  of  bed  trucks  are  in  use ;  that  de- 
signed by  Dr.  Mackintosh  of  the  West- 
ern Infirmary,  Glasgow  (Fig.  365),  pro- 
vides for  a  fixed  foot,  with  large  casters 


on  the  head  end;  when  the  patient  is  to 
be  moved,  the  nurse  or  orderly  throws  a 
lever  at  the  foot  of  the  bed,  forcing  down 
a  fifth  leg  with  large  caster,  thus  raising 
the  foot  of  the  bed  from  the  floor.  This 
leaves  the  bed  on  three  large  casters, 
ready  to  be  moved  with  the  slightest 
efifort.  A  similar  bed  is  now  manufac- 
tured by  American  makers  (Fig.  366). 
The  single  staff  bed  truck,  used  in  a 
similar  way,  is  quite  effective  (Fig.  367). 
A     fracture     bed     having     a     certain 


FIG.    365.    MACKINTOSH    BED    ADJUSTER. 

amount  of  resilience  is  now  made  with 
steel  slats  or  carriage  springs.  The  most 
popular  is  the  open  pattern,  which  is 
easily  cleaned  and  adjusted. 

The  two-piece  maternity  bed,  which 
allows  for  the  removal  of  the  foot  half 
and  adjustment  of  the  stirrups,  is  gen- 
erally coming  into  service  in  maternity 
hospitals.  The  illustration  (Fig.  368)  is 
that  of  a  bed  found  by  the  writer  in  Ber- 
lin in  1913.  x\merican  manufacturers, 
however,  have  improved  on  this  in  many 
details  (Fig.  369). 


218 


THE  AMERICAN  HOSPITAL 


The  bedside  table  is  perhaps  the  next 
in  importance  in  the  patient's  outfit;  for, 
in  the  ward,  it  contains  prized  posses- 
sions, and  is  subject  to  many  uses.  Its 
contents  should  not  be  subjected  to  the 
gaze  of  the  occupant  of  the  next  bed ;  at 
the  same  time  it  should  be  open  enough 
for  good  ventilation.  It  should  be  ad- 
justable so  as  to  serve  for  an  "invahd" 
or  over-the-bed  table  (Fig.  370;  ;  an- 
other t}"pe  shown  (Fig.  364)  fastens  di- 
rectly to  the  bed  and  requires  no  floor 
space.  For  private  rooms  not  connected 
with  private  baths,  the  utilities  such  as 
bed-pan,  bowl,  pitcher,  etc..  may  be  ar- 
ranged on  the  doors  of  a  bedside  cabi- 
net and  so  kept  out  of  sight. 

In  the  private  rooms  the  furniture 
should  be  refined  and  simple  in  lines, 
open  underneath  to  facilitate  cleaning. 
Plate  glass  tops  placed  over  scarves  of 


the  same  material  as  furniture  covering 
or  curtains  help  to  bring  the  room  into 
harmony.  Chairs,  of  course,  should  be 
comfortable :  if  upholstered,  they  should 
have  removable  covers. 

Footstools  are  always  desirable.  Those 
made  similar  to  the  Pullman  car  porters' 
stools  have  the  advantage  of  stabilitv 
(Fig.  372 j. 

For  mattresses,  nothing  has  been 
found  more  comfortable  than  a  good 
quality  hair.  Both  hair  and  feather  pil- 
lows should  be  provided;  and  the  small 
■'comfort"  pillow  or  bolster,  about  five 
inches  in  diameter  and  eighteen  inches 
long,  often  eases  the  aching  back  or  re- 
lieves the  pain  of  a  fractured  limb  and 
is  also  of  great  service  in  the  maternity 
department. 

There  might  be  added  to  the  private 
room  a  good  picture  or  two.     Hung  with 


FIG.  266.    FIXED   BED  TRUCK. 


OF   THE   TWENTIETH   CENTURY 


219 


a  short  cord  directly  from  the  back,  they 
are  easily  taken  down  for  cleaning. 

A   rug,   preferably  washable,   may  be 
added  with  good  effect. 


The  hangings  for  the  windows  also 
should  be  washable. 

Care  of  patients'  clothing  might  well 
be  discussed  here.  In  some  hospitals,  the 
clothing  of  the  ward  patients  is  carefully 
put  into  individual  lockers  and  the  keys 
turned  over  to  the  patient,  although  he 
himself  never  sees  the  lockers ;  in  others, 
"pigeonholes"  or  small  bins  are  pro- 
vided for  each ;  and  in  still  others,  the 
clothing  of  one  patient  is  hung  side  bv 


FIG.    367.    PORTABLE    ONE-PIECE    BED    TRUCK 
AND  IRRIGATOR  STAFF. 


FIG.   368.    TW^O-PART   MATERNITY    BED,    EURO- 
PEAN   MAKE. 


FIG.   369.    TWO-PART  MATERNITY  BED,   AMERICAN   MANUFACTURE. 


220 


THE  AMERICAN  HOSPITAL 


FIG.   370.    ADJUSTABLE   BEDSIDE  TABLE. 

side   with   that   of   others   in  a   clothing 
room. 

The  method  adapted  by  the  writer 
from  the  system  used  in  the  Munich- 
Schwabing  Hospital  (Fig.  373)  is  that 
of  cloth  lockers  or  bags  of  sufficient  size 
to  hold  the  clothing  without  folding.  The 


FIG.  370A.     ADJUSTABLE  BEDSIDE  TABLE,  WITH 
TOP    EXTENDED    OVER    BED. 

bag  is  oblong,  about  eight  by  sixteen  by 
fifty  inches  high,  and  is  held  in  place  by 
wire  grilles  at  top  and  bottom ;  from  the 
top  grille  a  hook  extends  through  the 
top  of  the  bag  and  serves  to  hang  the 
bag  to  the  pipe  rack  erected  for  the  pur- 
pose ;  from  the  top  grille  is  suspended  a 
garment  hanger,  with  additional  hooks 
for  small  garments.  The  bottom  grille 
serves  to  hold  shoes  and  small  articles. 
The  clothing  can  be  placed  in  this  bag  by 
the  patient,  in  the  admitting  room,  and 
taken  to  the  clothing  room  on  a  truck  pro- 
vided for  the  purpose  (Fig.  374). 


FIG.      37L     PORTABLE      BEDSIDE      TABLE,      AT- 
TACHED TO   SIDE  OF  BED. 


FIG.    372.    PATIENT'S    FOOTSTOOL. 


OF  THE   TWENTIETH   CENTURY 


221 


FIG.  m.    CLOTH  LOCKERS  FOR  PATIENTS'  CLOTHING. 


Great  care  should  be  taken  in  equip- 
ping the  operating  department. 

Sterilizers  for  hospital  uses  have,  to  a 
certain  extent,  become  standardized  and 
are  manufactured  by  numerous  special- 
ists in  that  line.  The  selection  of  the 
best  is  oftentimes  a  matter  of  personal 
judgment,  but  as  with  other  hospital 
utilities  there  are  certain  underlying 
principles  involved,  whoever  makes  the 
apparatus. 

In  the   dressing   sterilizer   one   should 


be  able  to  sterilize  all  dressings,  sponges, 
and  other  goods  needed  in  the  opera- 
tions, and  have  the  same  dry,  ready 
for  use.  To  do  this,  a  steam  pressure  of 
about  fifteen  pounds,  for  a  sufficient 
length  of  time,  or  super-heated  air,  or 
both,  is  necessary.  The  size  of  the  ap- 
paratus depends  on  the  needs  of  the  in- 
stitution. In  xA.merica  the  most  common 
forms  are  the  horizontal  cylindrical  and 
the  globular ;  while  in  European  hos- 
pitals the  vertical  cylindrical  type  or  the 


tLtVATIOM      or       tA.CK 
CljOTttlKG    tOOVV 


tLtVATIOM/  Of  TtUCK 


DtTAiLT    or    Bag 


■Plam     or     TaucK 


fLAhl        0^         t,ACK 


HO/f ITM-  CLOTHING  -  K,tCtPTACLt/ 


tDWAlD  f  /TtVEKJ-  ~  AUCHITtCT 
£iO/T0M~MA// 


FIG.  373A. 


222 


THE  AMERICAX  HOSPITAL 


,1 

'  #j. 

•Wl^ 

■    Pm*^jE^Bf-  ' « 

-Kt 

MM  I 

^K^Hf  ^ 

■ 

FIG.  376.    BOX  STERILIZERS,  BUILT  INTO  WALL. 
OPEX. 

cabinet  form  is  used.  A  shape  which 
admits  of  baskets  or  semi-closed  boxes 
faciHtates  handling  the  dressings.  The 
box  steriHzer  shown  in  Figs.  376  and 
377,  recently  erected  in  the  Royal  Vic- 
toria Hospital,  has  some  advantages  over 
those  of  the  same  type  found  in  Europe 
— principally  in  that  the  air  is  super- 
heated and  steam,  at  a  less  pressure  than 
formerly,  is  introduced.  The  bacterio- 
logical tests,  however,  show  absolute 
sterility. 

The  sterilizers  for  basins  should  be  of 
sufficient  size  to  hold  what  will  be  needed 
in  an  operation  and  should  have  an  auto- 
matic lift  both  for  cover  and  tray,  either 
foot  power  or  hydraulic. 

For  instruments,  gloves,  etc..  smaller 
sterilizers  may  be  used,  but  the  same 
principles  should  prevail  as  in  the  larger. 

A  tank  for  saline  solution,  with  ther- 
mostatic control,  is  a  desirable  addition. 

The  sterile  water  to  be  used  in  dress- 
ing, in  irrigation,  or  for  cleaning  the 
hands  during  operation,  must  be  most 
carefully  prepared. 

Bacteriologists  assert  that  all  of  the 
harmful  life  is  not  destroyed  at  one  boil- 
ing; but  that  to  obtain  absolute  sterility, 
the  process  must  be  continued  for  three 
consecutive  days,  and  even  then,  with 
careful  filtration,  minerals  and  solids  are 
not  removed.  If  they  are  right,  safety  to 
the  patient  will  not  permit  the  use  of  any- 
thing but  distilled  water  for  operation 
purposes.     The  water  stills  have  become 


FIG.  377. 


BOX  STERILIZERS,  BUILT  IXTO  WALL. 
CLOSED. 


standardized  to  such  an  extent  that  stills 
of  almost  any  size  can  be  procured  in  the 
market. 

If  sterile  water  is  needed  in  a  number 
of  different  parts  of  the  institution,  it  is 
more  advantageous  to  place  the  w^ater 
still  and  receiver  in  an  elevated  position, 
conducting  the  distilled  water  by  gravity 
through  tin-lined  pipe  to  the  various 
points  needed,  Avhere  a  local  instantane- 
ous heater  can  be  located,  with  steam  or 
electric  heating  unit.  Water  from  the 
same  still,  through  a  separate  storage 
tank,  can  be  used  for  drinking  purposes 
for  the  institution,  as  in  the  Royal  \"ic- 
toria  and  the  Ohio  A'alley  General  Hos- 
pitals. 

It  often  happens  in  small  hospitals  that 
no  high  pressure  steam  or  gas  is  avail- 
able for  heating  sterilizers.  Electricity 
or  even  kerosene  oil  can  be  used. 

The  equipment  for  the  operating  rooms 
should  be  governed  by  the  needs  of  the 
surgeons.  A  table  with  the  numerous 
necessary  adjustments,  instrument  and 
utensil  tables,  stools  for  both  surgeon  and 
anaesthetizer,  and  receptacles  for  soiled 
dressings  are  among  the  necessary  items. 
If  the  room  is  fitted  for  compressed  air, 
nitrous  oxide  gas,  oxygen,  and  steam,  the 
work  of  the  surgeon  is  facilitated. 

Cabinets  for  dressings,  instruments, 
and  blanket  warming,  either  built-in  fas 
in  Fig.  83)  or  portable,  are  necessary  in 
the  operating  equipment. 

The  newer  tvpe  of  alcohol  dispensers. 


OF   THE   TWENTIETH   CENTURY 


223 


FIG.    3;y.     SECTION    OF    SLXK    KOU.M. 

where  only  so  much  hquid  as  is  needed 
is  released  by  foot  pedal  action,  is  con- 
sidered an  economy,  and  in  using  this  no 
two  persons  immerse  their  hands  in  the 
same  fluid  (Fig.  82). 

Demand  for  a  room  where  the  dirty 
work  of  the  ward  unit  can  be  done  has 
developed  what  is  commonly  termed  a 
sink-room  or  work  room.  In  the  older 
hospitals  one  will  find  no  such  room,  and 
the  work  now  being  done  in  this  room 
was  usually  done  in  the  toilet  room,  with 
the  bed-pans  and  urinals  placed  on  the 
walls  or  wherever  there  Avere  a  few 
square  inches  of  space.  The  need  of 
such  a  room  is  great.  Here  not  only  are 
the    bed-pans    discharged,    washed    and 


FIG. 


380.    SECTION    OF    SINK    ROOM,    SHOWING 
STERILIZER    AND    INCINERATOR. 


sterilized,  but  there  should  be  a  place  for 
the  preservation  of  specimens  in  a  cool, 
ventilated  space,  opportunity  for  the  boil- 
ing of  catheters,  making  of  poultices,  etc. 

There  should  be  a  local  incinerator  in 
this  room  for  the  destruction  of  all  ward 
waste,  faded  flowers,  etc.  (Fig.  380.) 
There  should  be  a  sink  for  the  washing 
of  rubber  sheets  and  utensils,  and  an  ice- 
box for  crushed  ice ;  in  short,  this  should 
be  a  room  which  can  be  the  general  work- 
room of  the  section. 

If  there  is  no  local  laboratory,  this 
room  will  often  serve  the  purpose. 

The  disinfecting  room  in  the  general 
hospital  should  have  either  a  steam  pres- 
sure disinfector  or  a  hot-air  and  formal- 
dehyde disinfector,  or  both,  and  room  for 
the  storage  of  mattresses  after  disinfec- 
tion. 


224 


THE  AMERICAN  HOSPITAL 


H^               ■ 

1    ' 

ini 

FIG.    383.    AUTOMATIC   LIFTS   FOR    FOOD    CARS. 


FIG.    388.    OPEN    FOOD    TRUCK. 


FIG.    382.    OHIO    VALLEY    GENERAL    HOSPITAL.    SERVING    KITCHEN. 


OF  THE  TWENTIETH  CENTURY 


225 


FIG.    381.    ST.    LUKE'S    HOSPITAL,    NEW    BEDFORD,   MASS.    SERVING    KITCHEN. 


FIG.  384.    BRIDGEPORT  HOSPITAL.    DIET  KITCHEN,   SHOWING  CABINET  FOR  HOT  AND  COLD 

DISHES. 


226 


THE  AMERICAN  HOSPITAL 


FIG.   387.    CINCINNATI   GENERAL   HOSPITAL.    SERVING   KITCHEN,   SHOWING    FOOD  TRUCK. 


FIG.   389.     HOSPITAL   FOR   SICK   CHILDREN.     PASTEURIZING   ROOM. 


OF  THE   TWENTIETH  CENTURY 


227 


FIG.    385.    HEATED     FOOD    TRUCK. 

Heat     IS     applied    by     inserting    hot     soapstones     in 

pockets    at    sides. 


228 


THE  AMERICAN  HOSPITAL 


CHAPTER  XVII. 


Hanbficape  ^rcljitecture  asi  ^pplieb  to  J^osipitalsi 


There  are  greater  possibilities  for  the 
care  of  the  convalescent  in  suitably 
planned  grounds  around  a  hospital  than 
within  the  walls;  and  when  locating  the 
buildings  for  a  suburban  hospital  especial 
accessibility  to  the  grounds  should  al- 
ways be  considered. 

Wherever  one  goes  in  any  of  the 
larger  institutions  of  Europe,  one  will 
see  the  convalescent  patients  walking  or 
being  wheeled  along  the  shady  paths,  sit- 
ting under  special  arbors  or  awnings,  en- 
joying the  green  grass  and  the  flowers, 
and  chatting  with  one  another.  Com- 
fortable benches  and  easy  seats,  splash- 
ing fountains,  and  simple  forms  of 
amusement,  all  add  to  the  pleasure,  and 
shorten  the  convalescence.  Walks,  with 
frequent  benches  for  resting,  should  be 
provided.  At  the  Virchow  Hospital 
(Fig.  1),  several  acres  are  devoted  to 
the  park  in  addition  to  the  well  laid  out 
and  well  equipped  grounds  of  the  hospi- 
tal. In  this  park  the  staft',  the  nurses, 
the  male  and  female  patients  are  allowed, 
but  on  different  days ;  so  that  it  becomes 
a  private  park  for  the  enjoyment  of  all. 
(See  Fig.  400.) 

In  selecting  the  site,  not  only  the  ex- 
posure and  the  protection  from  cold 
winds  should  be  considered,  but  the  views 
from  the  hospital,  the  possible  vistas 
from  the  wards  or  balconies.  If  the  out- 
look is  depressing  in  one  direction,  it 
should  be  screened  by  a  slight  change  in 
the  location  or  by  planting  out  the  view. 

The  site  selected  may  have  most  beau- 
tiful trees  which  the  hospital  authorities 
demur  about  having  cut ;  but  if  the  build- 
ings cannot  be  placed  to  advantage  with- 
out this  cutting,  then  the  test  applied  by 
some  landscape  architects — "If  the  tree 
were  out  of  the  way,  would  you  wish  one 
in  that  place?" — is  a  very  good  one  to 
apply. 

Runways  of  easy  grade  from  the  floor 
level  to  the  ground  are  always  desirable. 


The  planting  should  be  carefully 
planned  under  the  direction  of  some 
landscape  architect  of  ability,  so  that  the 
trees,  the  shrubs,  the  grass,  and  the  flow- 
ers bear  the  right  relation  to  one  another 
and  to  the  architecture  of  the  building. 
Shade  should  be  provided  where  shade  is 
needed,  and  care  exercised  not  to  plant 
too  near  the  building  so  as  to  cause  too 
much  shade ;  shady  walks  are  desirable, 
but  shaded  buildings  never,  for  with  the 
shade  comes  dampness  and  chill,  there- 
fore sunlight  should  reach  the  buildings 
wherever  possible. 

The  tendency  of  many  land^cape  archi- 
tects to  mass  shrubbery  against  a  build- 
ing, leaving  the  building  as  a  background, 
while  it  may  enhance  the  beauty  of  the 
architecture  or  sometimes  hide  it,  is  very 
apt  to  shade  a  portion  of  the  building 
which  needs  the  sunlight.  It  is  as  true  in 
landscape  planning  as  in  building  plan- 
ning that  the  patient  must  be  considered, 
and  the  therapeutic  and  healing  benefits 
of  the  sun's  direct  rays  must  outweigh 
the  architecture ;  for,  as  was  said  in  an- 
other chapter,  the  hospital  is  built  for  the 
patient  and  not  for  the  glorification  of 
the  architect  or  his  running  mate,  the 
landscape  architect. 

In  the  laying  out  of  the  patients'  lawn 
or  patients'  court,  the  planting  should  be 
so  arranged  as  to  act  as  a  screen  from  the 
public,  as  shelters  to  benches,  and  as 
shields  against  the  prevailing  cold  winds. 

Fountains  and  pools,  a  rustic  bridge 
and  aquatic  plants,  if  space  and  facility 
admit,  and  plenty  of  green  grass  add 
materially  to  the  interest.  If  there  are 
grades,  these  grades  should  be  gentle, 
for  the  convalescent  must  be  encouraged. 
All  these  things  help  the  patients  who 
are  just  recovering  from  an  operation  or 
convalescing  from  a  fever  to  enjoy  God's 
great  out-of-doors. 

Just  a  few  examples  by  way  of  show- 
ing how  some  institutions  have  cared  for 


OF   THE   TWEXTIETH   CENTURY 


229 


the  artistic  effect  as  well  as  for  the  com- 
fort of  the  patient : 

In  the  general  plan  for  the  Xczcto>i 
Hospital  (Figs.  401-407)  will  be  seen  a 
development  extending  over  a  score  of 
years.  When  expansion  was  necessary 
more  land  was  acquired,  buildmgs  altered 


and  moved,  and  the  scope  of  the  plant 
increased.  The  whole  group  was  brought 
into  greater  harmony  by  a  careful  study 
of  the  landscape  possibilities,  which  were 
carried  out  under  the  able  direction  of 
^Ir.  Herbert  J.  Kellaway.  Roads  were 
changed,     walks    created,    objectionable 


230 


THE  AMERICAX  HOSPITAL 


FIG.  401. 


FIG.  402.    XEWTOX  HOSPITAL.    ENTRANCE  TO  GROUNDS. 


OF  THE  TWENTIETH  CENTURY 


231 


FIG.   403.    NEWTON    HOSPITAL.        FOUNDERS'    MEMORIAL. 
Kendall,   Taylor   &   Stevens,   Architects. 


FIG.    404.    NEWTON    HOSPITAL.    GROUP    VIEW, 
Kendall,  Taylor  &  Stevens,   Architects. 


232 


THE  AMERICAN  HOSPITAL 


FIG.    406.    NEWTOX    HOSPITAL.    PATHWAY   TO    NURSES'    RESIDEX'CE. 
Herbert  J.   Kellaway,   Landscape  Architect. 


FIG.    405.    XEWTON    HOSPITAL.    VIEW    IX    GROUNDS. 

Herbert  J.  Kellaway,   Landscape  Architect. 


OF   THE   TWENTIETH   CENTURY 


233 


'  jidjjujua 

■g 

^■H^'^^/dM 

M 

^^H 

■ 

^"^^-^      «^^9H^^H 

^P 

^^^^^  ^^hShH 

■ 

hb 

H 

1 

^H 

1 

1 

I 

IwR  ''*<^^^^^K9^1 

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1 

1 

-  ~ J^^B^^B 

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^^^^H 

^H 

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W'tBiiIMI  "  Jf^/^JA' ^-..■it-  ,<<±if..-.&ih  .f,ift«,->«i  i:  ■a»7^ 

3^1«=^.« 

^^.:^.^„ 

i.jvtf-j^^.,-.^ « 

.---^ 

FIG.  407.    XEWTOX  HOSPITAL.    WAITING   LODGE. 


FIG.   407A.    NEWTON    HOSPITAL,    GROUP   VIEW. 
Kendall,  Taylor  &  Stevens,   Architects. 


234 


THE  AMERICAN  HOSPITAL 


-A 


\-- 


a 


,'j 


-5" 


tffcj- 


.V  >^^ 


TALiTHA 
y^vATERNiTY 

JAMAICA  PLAi\', 
AASaACHV5ETT5. 


COWARD  ■ 
-BRCH 
b05T0N 


^'^Cw  ,    .     V,       KlATERNlTT  HDKa     /j 


^  I 


FIG. 


OF  THE  TWENTIETH  CENTURY 


235 


Fian5  0fGround5  Of 


TnL5E.VmLYll05PITAL.  BevERLY.MAii. 
^^"^T^r""'  ARatnT.Cr5.D05TCN. 


FIG.  409. 


Green      St. 


FIG.    410.    HEYWOOD    MEMORIAL    HOSPITAL,    GARDNER,    MASS. 

Kendall,   Taylor   &   Stevens,   Architects. 

Herbert   J.   Kellaway,   Landscape   Architect. 


236 


THE  AMERICAX  HOSPITAL 


views  planted  out.  tennis  courts  built,  and 
the  whole  brought  into  harmony. 

In  the  Talitha  Cumi  ^Maternity  Home 
(Fig.  408)  the  careful  study  of  the  pos- 
sibilities of  the  best  location  with  the 
landscape  architect  before  planning  the 
buildings  led  the  architect  to  take  ad- 
vantage of  the  natural  beauty  of  the 
i-'ther  restricted  site. 


At  the  Beverly  Hospital  (Fig.  409) 
at  Beverly,  ]\Iass.,  and  the  Henry  Hey- 
wood  Alemorial  Hospital  (Fig.  410)  at 
Gardner,  Alass,  the  problems  were  simi- 
lar. Steep  grades  Avere  encountered  and 
easy  approaches  considered,  all  to  give 
not  only  a  comfortable  and  dignified  ap- 
proach but  one  which  would  show  the 
buildings  to  the  best  advantage  and  at 


DojAMiN  JricRNEy  Ca5ll  jIoiowal  McOPITAL' 

IPJWICH-    MAJ3 

CcNC:KAL?lAN  ronAKRANCDIENTOrQoUNDJ' 


Ayynn.kyivrju.rF  Lakdjcap*.  AKCH)xtCT- 

iTKTL  yr.  DftSTON    ^lAJJ. 

I»  CoiuuLTATioA  With  twtnn  1? Jttvejij  -Mc«ni<T- 

Ao<5-;gife 


FIG.  4n. 


OF   THE   TWEXTIETH   CENTURY 


237 


the  same  time  screen  the  patients  from 
the  view  of  approaching  carriages.  Study 
was  made  of  the  approach  of  service 
drives  to  kitchen  and  morgue. 

The  site  selected  for  the  httle  hos- 
pital at  Ipswich,  the  Benjamin  Stickney 
Cable  Memorial  Hospital  (Fig.  411  j, 
was  in  the  beginning  a  barren  field; 
and  the  problem  given  to  the  land- 
scape architect,  was  to  re-create  the  site 
by  planting  trees  and  shrubs,  to  make  an 
easy  aproach  to  both  front  and  ambu- 
lance entrances,  to  make  an  approach 
from  the  street  car  line  to  the  building, 
and  at  the  same  time  to  screen  all  of 
these  approaches.     The  high  wall  of  the 


patients"  court  and  the  location  of  the 
airing  balconies  made  this  possible.  This 
patients'  court  has  private  walks  and  pa- 
vilions and  seats   for  the  convalescents. 

With  the  city  hospital  on  restricted 
land,  small  opportunity  may  exist,  but 
what  little  there  is  to  be  done  should  be 
considered  wisely.  One  rarely  sees  a 
more  charming  approach  to  a  city  hos- 
pital than  that  to  the  Phipps  Psychopa- 
thic Clinic  at  the  Johns  Hopkins  Hos- 
pital. 

If  the  architects  can  make  the  ap- 
proach to  their  hospitals  speak  the  wel- 
come that  they  try  to  express  in  the 
entrance  to  the  buildings,  they  will  go  a 
long  way  toward  expelling  the  fear  of 
entering  an  institution. 


FIG.   412.    AX   OLD   PEOPLE'S   HOME.    VIEW   OF 

GROUNDS.  FIG    413.    PORTABLE    SEAT,   WITH   AWXIXG. 


238 


THE  AMERICAN  HOSPITAL 


FIG.   414.    ROYAL   VICTORIA    HOSPITAL,    ROSS    PAVILION.    ENTRANCE    GATES. 
Stevens   &  Lee,  Architects. 


OF  THE  TWENTIETH  CENTURY 


239 


CHAPTER  XIX. 


^ar  ||o£jpital2i 


In  this  volume,  the  writer  has  merely 
touched  on  a  few  of  the  many  hundred 
hospitals  which  have  been  erected  in 
America  since  the  beginning  of  the  cen- 
tury and  has  tried  to  point  out  a  few  of 
the  general  examples  of  European  insti- 
tutions and  to  show  how  hospital  im- 
provements in  planning  and  technique 
have  been  carried  out  in  America. 


This  volume  would  not  be  complete 
without  touching,  at  least,  on  the  hospi- 
tals already  built  for  war  purposes. 

During  the  past  season,  the  United 
States  has,  through  the  Medical  Depart- 
ment and  the  Quartermaster's  Depart- 
ment, erected  large  hospitals  at  each  can- 
tonment and  National  Guard  encamp- 
ment.    These  hospitals  have   been  con- 


FIG.  420. 
Charles  Butler,  Architect. 


240 


THE  AMERICAN  HOSPITAL 


structed  of  wood,  are  one  story  in  height, 
and  each  hospital  comprises  a  group  of 
about  sixty  buildings,  connected  by  en- 
closed corridors.  Each  ward  accommo- 
dates thirty-two  patients. 

In  France  and  England,  however,  we 
find  plenty  of  good  examples.  The  field 
hospitals  are  largely  of  the  portable 
"knock-down"'  construction.  About  the 
cities,  however,  many  permanent  new 
hospitals  have  been  and  are  being  built. 

In  the  war  hospital  at  Issy-les-Mouli- 
neaux,  near  Paris,  France,  Mr.  Charles 
Butler,  an  American  hospital  architect, 
working  with  the  American  Clearing 
House  in  Paris,  with  French  military  en- 
gineers and  architects,  has  developed  a 
plan  embodying  the  good  points  of  the 
American  as  well  as  of  the  European  in- 
stitutions. Mr.  Butler's  own  description 
of  the  hospital  follows : 

"The  permanent  Military  Hospital  at 
Issy-les-Moulineaux  (Figs.  420-428)  is 
planned  to  contain  five  hundred  beds,  of 
which  approximately  two-thirds  are  for 
sick  and  wounded,  and  one-third  for 
contagious  diseases. 


"The  site  is  a  high  plateau,  with  a 
slight  slope  toward  the  north.  The  gen- 
eral entrance  lies  on  the  east,  the  Ad- 
ministration Building  being  close  to  the 
road,  while  behind  it  lies  the  Reception 
Building,  which  in  a  war  hosptial  is  even 
more  important  than  in  an  ordinary  one. 

"The  wounded  arrive  by  automobile 
ambulances  and  are  taken  into  the  Salle 
de  Reception,  the  stretchers  teing  placed 
in  a  row  in  the  back  of  the  room,  and 
benches  being  provided  for  seated  cases. 
After  rapid  examination  by  the  surgeon 
in  charge,  the  wounded  pass  to  the  Salle 
de  Nettoyage  or  clean-up  room,  where 
their  soiled  clothes  are  removed  and  they 
are  bathed  on  high  fiat  tubs.  Mean- 
while their  valuables  are  checked,  soiled 
clothes  go  into  the  soiled  clothes'  wagons 
and  clean  linen  is  provided  from  the  ad- 
jacent linen  room.  With  this  system 
every  man  reaches  his  ward  clean  and 
with  clean  linen,  although,  in  general,  no 
new  dressings  have  been  attempted,  ex- 
cept where  a  bandage  may  have  become 
loose  or  has  slipped  out  of  position. 

"At  the  other  end  of  this  building  is 


■  PAVIULOM-  DEI- RECEIPTION    DE;b- BLElbbEl'b     ET    A^AU/i  DELS 


FIG.  421.    MILITARY  HOSPITAL  AT  ISSY-LES-MOULINEAUX. 


OF   THE  TWENTIETH   CENTURY 


241 


the  storage  room,  where  what  is  mend- 
able  of  the  uniforms  come  back  after  dis- 
infection, and  between  the  store  room 
and  the  receiving  room  is  the  file  room 
for  records,  etc.,  where  the  discharged 
soldier  passes  to  secure  his  belongings  be- 
fore leaving  the  hospital. 

"The  reception  pavilion  ii:  connected 
to  the  diiTerent  pavilions  of  the  hospital 
by  covered  ways  enclosed  in  glass  and 


heated  so  that  the  wounded  man,  after 
being  washed  up,  does  not  go  out  doors 
to  reach  the  ward  to  which  he  has  been 
assigned. 

"The  general  arrangement  of  the 
wards  is  on  the  north  and  south  axis,  the 
corridors  giving  entrance  to  the  north 
end  of  each  ward,  while  the  south  end  is 
very  open,  giving  the  greatest  possible 
amount  of  sunlight.    At  the  south  end  of 


-T  O 


242 


THE  AMERICAN  HOSPITAL 


LAB0P.AT01RE 


l/I 


REZ-  DE  -C  HA^SSEEL  -BAS> 


ELCHEULE       l^E     O.cl    P.  A\ 

FIG.  423.    MILITARY  HOSPITAL  AT  ISSY-LES  MOULIXEAUX. 


AL-lENj;:i>    ELT-   DE1TE1NZ_;;>  1 


© 


-Ml 

e 

-& 

-fi- 

e 

s 

s 

B- 

B- 

S- 

^5 

S 

^ 

i  ^ 

PF*EA£i        C0UVE:R.T 

FIG.  424.    MILITARY  HOSPITAL  AT  ISSY-LES-MOULIXEAUX. 


OF   THE   TWENTIETH  CENTURY 


243 


each  ward  is  placed  a  terrace,  arranged 
to  be  protected  by  awnings  in  summer. 
At  the  extreme  north,  forming  a  shield 
for  the  ward  buildings,  are  the  pharmacy, 
operating  pavilion  and  laboratory  build- 
ing. Each  of  these  buildings,  owing  to 
the  slope  of  the  ground,  has  a  complete 
basement  for  storage  purposes.  The 
pharmacy  and  laboratory  plans  need  no 
special  comment.  In  the  case  of  the 
operating  pavilion,  there  should  be  noted 
the  arrangement  of  the  plaster  room  for 
fracture  work  in  close  proximity  to  the 
operating  room,  and  scheme  of  plan  by 
which  nurses  and  orderlies  coming  to  the 
pavilion  for  sterilized  dressin.gs  for  the 
ward  dressing  rooms,  have  access  only 
to  the  room  where  dressings  are  prepared 
and  not  to  the  rest  of  the  building.  In 
the  operating  room  and  plaster  room  ar- 


rangements are  made  for  radiograph 
work  to  be  done  on  the  spot  in  case  it  is 
not  convenient  to  transport  patients  to 
the  X-ray  room.  The  physiotherapy 
pavilion  opposite  the  operating  pavilion 
is  of  especial  use  for  work  (electrical, 
mechanical,  etc.)  for  the  re-education  of 
wounded  members. 

"The  general  plan  of  the  w  ards  proper 
offers  nothing  especially  new,  except  the 
acceptance  by  the  French  military  au- 
thorities of  the  principle  of  small  wards. 
In  this  case  each  ward  contains  eighteen 
beds  with  four  additional  isolation 
rooms.  The  linen  room  is  placed  be- 
tween the  ward  and  the  isolation  rooms, 
with  glazed  sash,  allow^ing  supervision 
both  of  the  w^ard  and  the  isolation  rooms, 
while  from  the  diet  kitchen  or  office,  the 
ward  mav  also  be  seen. 


FIG.  425.    MILITARY  HOSPITAL  AT  ISSY-LES  MOULIXEAUX. 


PHAKA\AClt  ■ 


^EZ-DEL-Ct^AUSSclE:-    HALlT 


^ElZ-DEL-CHAUSbEC        BA>5 


FIG.   42SA.    MILITARY   HOSPITAL   AT   ISSY-LES-MOULINEAUX. 


244 


THE  AMERICAN  HOSPITAL 


"The  service  rooms  are  those  included 
in  our  typical  American  plans. 

"The  convalescent  pavilion,  placed  in 
the  garden,  comprises  a  large  game  room 


for  billiards,  shuffle-boards,  cards,  etc., 
with  a  small  canteen  adjoining,  where 
the  patients  are  allowed  to  purchase  one, 
or  at  most  two,  drinks  per  day. 


OF  THE  TWENTIETH  CENTURY 


245 


"At  the  other  end  of  the  building  is  "The  contagious  division  is  treated  as 
a  reading  room  with  a  small  circulating  a  separate  administrative  unit  with  en- 
library.  On  the  garden  side  is  a  cov-  trance  on  the  south  side  of  the  property 
ered  porch  extending  the  entire  length  of  and  a  service  building  containing  a  small 
the  building.  operating  room  and  record  office,  etc. 


PAVILLONI   o'OFriClERS- 


FIG.  427.    MILITARY  HOSPITAL  AT  ISSY-LES-MOULINEAUX. 
PAVILLON      0PE:F<>AT0I  PsEI 


=^^?=>  I  n=^=^=^p=^=r=Efi3r^  I  C=I^3=^ 


I^ 


=(3^ 


i^S: 


^y  .irg 


REZ-  DE-CHAOb^EEl-BAt. 

EiCHEui-e:     de:    o  ol  p  /v\. 
FIG.  428.    MILITARY  HOSPITAL  AT  ISSY-LES-MOULINEAUX. 


246 


THE  AMERICAN  HOSPITAL 


Li_l 


■2001-3300  a3a3AOD 


I 

d^l 

Q.a_2 — 
oO 


'ioai's'io'i         asiaAOD 


r:? 


iJ 


OF  THE  TWENTIETH  CENTURY 


247 


"The  contagious  pavilions  themselves 
are  of  two  types,  four  being  arranged 
according  to  the  system  of  the  Pasteur 
Hospital,  in  Paris,  for  complete  isolation, 
and  two  for  isolation  in  groups  of  three 
or  four.  The  patients  are  brought  into 
their  rooms  through  the  glazed  doors 
leading  to  the  terrace  which  surrounds 
each  of  these  pavilions,  and  while  under 
treatment  there  is  no  necessity  for  the 
patient  leaving  his  room,  the  movable 
bath  being  brought  in  when  necessary, 
while  nothing  need  be  taken  out  of  the 
room,  as  each  room  contains  a  toilet  fix- 
ture and  a  wash  basin.  Each  pavilion 
contains  a  discharge  room  with  bath,  for 
patients  leaving  the  institution.  The  pa- 
vilions for  isolation  by  groups  would  be 
used  in  case  of  epidemics  where  enough 
cases  of  the  same  disease  were  present  to 
justify  it,  and  where  the  nature  of  the 
disease  permitted  grouping. 

"To  the  extreme  west  lie  the  small 
pavilions  for  patients  who  may  become 
insane  and  for  patients  under  arrest,  each 
patient  being  placed  in  a  separate  room. 

"The  morgue  and  chapel  (mortuary) 
is  also  in  this  corner  of  the  lot. 

"To  the  right  and  left  of  the  principal 
entrance  are  the  groups  of  buildings,  for 
nurses  on  the  right  and  for  orderlies  on 
the  left ;  these,  with  the  small  houses  for 
the  head  doctor  and  the  superintendent, 
being  the  only  two-story  buildings.  The 
nurses  have  all  single  rooms,  while  the 
orderlies,  being  soldiers,  are  grouped  in 
dormitories. 

"Owing  to  the  necessity  of  complying 
with  military  regulations,  a  separate 
kitchen  is  provided  for  the  orderlies. 
The  nurses,  however,  are  fed  from  the 
hospital  kitchen. 

"In  the  southeast  corner  of  the  prop- 
erty lies  the  service  group  with  its  own 
entrance,  directly  opposite,  which  is  the 
power  plant.  The  kitchen  and  laundry, 
both  run  by  steam,  lie  adjacent  to  the 
corridor,  which  gives  access  to  the  wards, 
so  that  food  can  be  transported  in 
wheeled  cars  to  the  main  group  and  to  the 
contagious  group. 

"East  of  the  kitchen  lies  the  bath  es- 
tablishment for  douches,  sulphur  baths, 
etc. 


"Along  the  east  front  of  the  property 
are  the  storage  buildings  and  along  the 
south  side  of  the  service  court  is  the 
mattress  repair  building. 

"It  is  to  be  noted  that  every  part  of  the 
plant  is  reached  by  covered  corridors, 
and  as  there  are  no  steps,  all  transport  of 
food,  patients,  etc.,  is  on  w-heels. 

"The  corridors  leading  to  the  con- 
tagious pavilions  are  closed  on  the  north 
side  only." 

Another  small  base  hospital  of  less 
permanent  nature,  which  was  also  de- 
signed by  Mr.  Butler,  on  the  unit  system 
of  construction,  and  erected  nearer  the 
front,  "Somewhere  in  France,"  is  here 
shown.     (Fig.  429.) 

The  plans  for  the  United  States  Over- 
seas Hospitals  were  just  finished  as  this 
book  was  going  to  press ;  and  at  the  ex- 
pense of  a  few  W'Ceks'  delay  in  giving  the 
book  to  the  public,  they  are  here  shown 
and  described.  The  planning  of  these 
buildings  was  placed  in  the  hands  of  Mr. 
Butler  and  the  writer  by  the  Engineer 
Depot  of  the  United  States  Army,  of 
which  Colonel  W.  H.  Rose  is  the  head. 
Not  only  the  plans,  but  all  the  details  of 
construction,  equipment  and  fixtures  have 
been  designed. 

These  units  consist  of  eighty-seven 
buildings  each,  and  comprise  all  the  es- 
sential departments  of  an  up-to-date 
hospital,  all  of  "demountable"  portable 
construction.  The  type  of  construction 
used  is  similar  to  that  employed  by  Mr. 
Butler  for  the  Rockefeller  Demonstra- 
tion Hospital  in  New  York. 

The  block  plan  (Fig.  430)  shows  the 
ideal  grouping  of  buildings ;  but  the 
actual  layout  on  the  ground  must  depend 
on  the  available  site,  on  the  contour  of 
the  land,  on  the  local  surroundings,  etc. 
The  orientation  of  certain  buildings  must 
always  be  considered  in  every  hospital 
group;  thus,  to  obtain  the  ideal  lighting 
of  the  ward  buildings,  the  wards  should 
run  north-south,  and  the  ideal  condition 
for  operating  buildings  is  to  have  the 
operating  rooms  face  the  north,  and  the 
aim  should  always  be  to  approximate  this. 

In  the  war  hospital,  especially  in  one 
near  the  front,  greater  facilities  must  be 
made  for  the  reception  of  the  patients; 


248 


THE  AMERICAN  HOSPITAL 


thus,  the  Receiving  Building  (Fig.  431) 
will  accommodate  a  large  number  of 
stretchers  at  one  time,  and  will  allow  for 
proper  segregation  and  classification  of 
the  patients,  the  taking  of  the  histories, 
etc.  The  Bathing  Room  adjoining  is  pro- 
vided with  high  slab  tubs.  In  this  room 
the  patient's  clothes  and  effects  are  re- 
moved, which,  after  washmg  and  fumi- 
gating, are  deposited  in  the  adjoining 
Patients'  Effects  Building,  No.  3  on  gen- 
eral plan. 

As  all  buildings  are  connected  by  en- 
closed corridors,  the  patient  can  be  taken, 
by  stretcher  or  otherwise,  to  the  operat- 
ing building  or  to  the  ward,  according  to 
his  condition. 

The  Operating  Buildings  (Fig.  432), 
two  in  number,  for  the  general  operating 
service,  consist  of  thoroughly  equipped 
suites  of  rooms  with  every  convenience 
of  a  modern  operating  unit  in  a  surgical 
hospital.  The  rectangular  shaped  build- 
ing, made  necessary  by  the  type  of 
construction  adopted,  does  not  interfere 
with  the  efficiency  of  the  plan  except, 
perhaps,  that  there  is  a  superabundance 
of  corridor.  The  operating  rooms  are 
provided  with  abundant  light,  by  means 
of  both  windows  and  skylights.  Between 
the  two  main  operating  rooms  is  the  ster- 
ilizing room,  and  sterile  water  is  brought 
to  the  scrub-up  sinks  in  each  operating 
room.  The  scrub-up  sinks,  while  they 
are  simple  enameled  sinks,  are  provided 
with  the  most  approved  elbow-action 
scrub-up  devices.  Steam  sterilizers  and 
blanket  warmers,  a  complete  X-ray  suite, 
a  plaster  room  and  general  utility  are  all 
provided. 

F'or  the  units  placed  near  the  front, 
the  two  buildings,  Nos.  4  and  5,  would 
be  needed,  providing  for  ten  operating 
tables. 

The  walls  of  the  operating  rooms  are 
rendered  smooth  by  an  additional  surface 
of  enameled  canvas,  while  the  floors  are 
cement. 

A  separate  operating  and  treatment 
building  is  provided  for  the  ear,  nose 
and  throat  (Fig.  433)  ;  another  for  the 
eye  (Fig.  434)  ;  and  another  for  the 
dental  and  laboratory  work   (Fig.  435). 

The  Ward  Building  (Fig.  436),  of 
which  there  are  thirty-two  in  each  unit, 


is  much  the  same  as  that  adopted  by  the 
French  and  English  army.  It  consists 
of  the  ward  of  thirty-two  beds  and  of  a 
twenty-foot  airing  balcony  at  the  soutli^ 
end.  The  ward  itself  is  22  feet  wide,  102 
feet  long,  and  has  twenty-four  windows. 
These  windows,  occupying  about  thirty 
per  cent,  of  the  wall  surface  and  opening 
from  the  top,  afford  the  maximum  of 
light  and  air. 

In  each  ward  there  are  six  emergency 
exits.  The  side  wall  panels,  hinged  at 
bottom  and  opening  out,  form  a  ramp, 
down  which  the  beds  can  be  run  in  case 
of  fire  or  other  cause  for  quick  exit.  The 
walls,  doors  and  roofs  being  double,  these 
ward  buildings  are  comfortable  in  both 
winter  and  summer. 

The  utilities  consist  of  a  linen  room, 
a  nurses'  office,  a  toilet  room,  a  surgical 
dressing  room,  a  small  serving  kitchen, 
a  small  office  for  the  military  attendant, 
and  an  isolation  room  for  a  delirious  or 
moribund  patient. 

In  each  group  there  are  three  Isolation 
Buildings  (Fig.  437)  for  the  care  of  com- 
municable or  contagious  diseases.  These 
provide  for  twenty- six  patients  each,  and 
are  planned  on  the  so-called  "Pasteur" 
or  single  room  system.  The  ten  single 
or  isolation  rooms  are  entered  from  the 
outside.  Each  room  is  self-contained, 
having  a  water  closet  and  a  sink  with 
special  elbow  faucets,  so  that  it  will  not 
be  necessary  for  a  patient  to  leave  the 
room  until  he  is  convalescent.  The 
service  of  food  and  attendance  to  the 
patient  are  from  the  inside  corridor. 
Provision  is  made  for  linen,  serving 
kitchen,  utility  room  and  discharge  bath. 
The  discharge  bath  is  approached  from 
the  outside  as  well  as  from  the  inside. 
For  convenience  in  bathing,  a  portable 
"slab"  bath,  which  can  be  wheeled  into 
any  room,  is  provided  with  water  served 
from  the  sink  and  drained  into  the  water 
closet  bowl.  The  attendant  can  readily 
give  the  bath,  clean  the  slab,  and  it  will 
then  be  ready  for  the  next  patient. 

There  are  two  convalescent  wards  in 
each  building. 

For  the  care  of  the  psychopathic  and 
neurologic  patient,  two  buildings,  called 
the  Neuro-Psychiatric  Wards  (Figs.  438 
and  439) ,  are  provided.  The  more  violent 


OF  THE  TWENTIETH  CENTURY 


249 


cases  are  confined  in  the  portion  set  apart 
for  them,  consisting  of  isolation  rooms, 
a  day  room,  and  a  room  with  continuous- 
flow  baths.  This  portion  of  the  building 
is  protected  by  wire  guards  to  prevent 
the  escape  of  patients.  The  milder  cases 
of  insanity  are  cared  for  in  a  different 
section  of  the  building. 

The  building  for  the  strictly  neurologi- 
cal cases  provides  special  bath  and  medi- 
cal treatment  rooms,  as  well  as  wards, 
day  room  and  rest  rooms. 

For  sick  officers,  two  Officers'  \\'ard 
Buildings  are  provided  (Fig.  440 j — one 
with  wards  and  semi-private  room,  and 
one  with  private  rooms  and  mess. 

For  the  convalescent  patients,  about 
fifty  per  cent,  of  whom  are  ambulatory 
or  walking  patients,  dining  rooms  or 
mess  halls  are  planned ;  also,  a  central 
bath  house.  For  recreation,  the  assem- 
bly hall  or  post  exchange  is  provided. 

So  much  for  the  buildings  for  the 
patients. 

The  administration  and  mechanical 
buildings  occupy  a  most  important  part 
in  each  group. 

In  the  Administration  Building  (Fig. 
441  j  are,  of  course,  the  offices  for  admin- 
istration, and  they  are  much  the  same  as 
ni  a  civilian  hospital.  Headquarters  for 
the  commanding  officer,  secretaries,  ma- 
tron and  pharmacist  are  provided,  as 
well  as  postal  and  telegraph  offices. 

The  commanding  officer  and  chief  sur- 
geon are  given  a  small  house ;  the  other 
officers  are  in  a  separate  building.  The 
female  nurses  have  separate  buildings, 
with  single  rooms  for  each  nurse.  Hos- 
pital Barracks  house  the  enlisted  men. 

The  Kitchen  Building  (Fig.  442)  is 
worked  out  with  great  care,  and  contains 
the  bakery,  the  bread  room,  the  main 
kitchen  and  the  scullery ;  also  a  complete 
ice  plant  for  cooling  refrigerators  in  this 
building  and  for  the  making  of  ice  for 
the  hospital.  High  pressure  steam  is 
used  largely  for  cooking,  and  this  is  ob- 
tained from  a  nearby  boiler  plant. 

The  dish  washing  is  accomplished  in 
a  small  building  (Fig.  443 j,  situated  be- 
tween the  kitchen  and  mess  halls ;  this 
building  serving  as  well  for  the  housing 
of  the  food  carts. 

The  process  of  serving  food  is  simple ; 


the  orderly  starting  with  his  food  cart 
first  obtains  his  quota  of  hot  dishes;  then 
goes  through  the  closed  corridors  to  the 
kitchen,  where  he  first  picks  up  the  bread 
required ;  next  to  the  hot  table  to  get  the 
hot  food,  then  for  the  dessert,  and  then 
through  a  closed  corridor  to  the  ward, 
where  the  food  cart  is  used  as  a  serving 
table,  and  the  patient  is  reasonably  sure 
of  getting  hot  food. 

The  Laundry  Building  (Fig.  444)  has 
been  planned  in  reference  to  efficient 
work.  The  soiled  clothes  are  entirely  at 
one  end,  where,  with  modern  machinery, 
they  are  sterilized,  washed,  dried,  ironed, 
and  folded,  and  then  taken  to  a  general 
storage  room  for  distribution. 

The  construction  of  these  buildings  is 
simple — all  of  one  story,  built  up  of 
standard  five-foot  units.  Notwithstand- 
ing that  they  will  be  of  portable  construc- 
tion, with  double  walls,  floors,  and  roofs, 
built  in  shops,  transported  to  the  war 
section  and  erected,  they  will  be  hy- 
gienic, easily  cleaned,  comfortable  in 
winter  and  summer,  and  painted  both 
inside  and  outside.  The  elevations  and 
sections  (Figs.  445  and  446 j  show  the 
general  type.  Connections  to  these  build- 
ings are  through  enclosed  corridors.  The 
general  appearance  of  the  interior  will 
be  like  the  Rockefeller,  a  view  of  which 
is  here  shown  (Fig.  447).  The  reproduc- 
tion of  a  few-  detail  drawings  will  show 
the  construction  adopted  and  the  simple 
standat'is  used  for  plumbing  fixtures. 

The  construction  of  the  trusses  is 
worthy  of  special  study.  The  utilizing 
of  available  material,  like  the  gusset 
plates  at  the  junction  of  wall  and  roof 
and  the  section  of  channel  iron  in  place 
of  the  usual  turn  buckle;  the  simplicity 
of  erection;  and  the  general  pleasing  ap- 
pearance in  the  wards  will  be  noted.  The 
standard  valve,  which  will  be  used  on  all 
sinks,  bowls,  and  slop  hoppers,  is  adapted 
for  the  surgeons'  scrub-up  with  elbow^ 
valves  and  spray  head,  for  bathing  slabs 
with  hose  extension,  and  for  general 
sinks  throughout. 

The  heating  system  is  so  laid  out.  with 
several  small  heating  plants,  that  no 
large  pipes  will  be  required;  in  fact,  a 
3-inch  pipe  is  the  largest  used  outside 
the  boiler  houses. 


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OVERSEAS  HOSPITALS,  U.  S.  ARMY.  EDWARD  F.  STEVEXS 
AXD        CHARLES        BUTLER,        ASSOCIATE        ARCHITECTS. 


OF  THE  TWENTIETH  CENTURY 


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263 


264 


THE  AMERICAN  HOSPITAL 


FIG.  444. 


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FIG.  443. 


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265 


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FIG.  446. 


OF  THE  TWENTIETH  CENTURY 


267 


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FIG.    447.    ROCKEFELLER    INSTITUTE    BASE    HOSPITAL    WARD. 
Butler    &   Rodman,   Architects. 


FIG.   448.    EXTERIOR   VIEW.     ROCKEFELLER   INSTITUTE    BASE    HOSPITAL    WARD. 
Butler   &   Rodman,   Architects. 


OF  THE  TWENTIETH  CENTURY 


269 


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Typical  Lnd  Lllvation  or  27-iOi-'  Building 


Ji.DLLltVATlON  or  SZ-iOi  £)UILDJ 


FIG.  449. 


270 


THE  AMERICAN  HOSPITAL 


Side  Sections 

■  0?  yu  5>txJ  To  Bt.  FoOoJtB  iji.  ?ti.ttjjjci 


FIG.  450. 


OF  THE  TWENTIETH  CENTURY 


271 


jff  Diyc  'SSSroR  details  or  RArrfjis 


272 


THE  AMERICAN  HOSPITAL 


Beams  g  Floor  Sections 


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FIG.  452. 


OF  THE  TWENTIETH  CENTURY 


273 


274 


THE  AMERICAN  HOSPITAL 


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expiration  of  a  definite  Pe«odj 
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after  the  date  of  borrowing,  as 
library  or  by  special  arrange- 
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DATE  BORROWED 

DATE  DUE 

DATE  BORROWED 

DATE  DUE 

■f       fv       , 

■■'  ^      X    O 

C28(i14i)mI00 

OCT  3 1  19 


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